Doctors say at-home screening for HPV could be an opportunity to 'eliminate a cancer'

Women should be offered take-home kits to screen for cervical cancer, doctors say in new guidelines aiming to reduce discrimination in health care.

Provinces are currently moving away from Pap smears, which are recommended at least once every three years for women aged 30 to 69. A doctor sweeps up cells in the cervix to spot lesions caused by the human papillomavirus (HPV). The abnormalities provide an early warning of changes that can become cancerous without treatment.

Instead of the Pap, a relatively new HPV test is being rolled in several provinces. The test detects high-risk types of the virus. Those aged 25 and 65 are offered it every five years, with slight variations from province to province.

Self-swabs for HPV — similar to the at-home rapid tests for the virus that causes COVID-19 — could significantly boost early detection, says Dr. Aisha Lofters, a scientist and family physician at Women's College Hospital in Toronto, and a co-author of a paper published in Monday's issue of the Canadian Medical Association Journal. 

At-home HPV testing would help overcome barriers such as being unable to take time off work for medical appointments, having a history of sexual trauma or a lack of awareness, Lofters said.

"This could be a really meaningful alternative to increase screening rates while doing so in a safe and comfortable manner."

Pap smear accuracy is around 60 per cent. But in HPV testing, which looks at DNA of the virus, the accuracy can rise to 90 per cent. Cancer scientists say that's why the older Pap screening needs to be repeated more often.

With the HPV test, doctors can be more confident that a negative result means the woman is in the clear, said Dr. Gina Ogilvie. She led pilot projects trials on the rollout of at-home tests across British Columbia.

"You have the same accuracy as if a clinician got that specimen," Ogilvie said of B.C.'s experience after sending out 10,000 kits for self-collection in rural and urban areas.

Cervical cancer screening hasn't reached everyone. 

Australia led the way with self-testing for HPV, where it's been a success. 

Ogilvie's found similar gains working directly with Indigenous leaders in her province as well as South Asian women in Surrey. People can request kits, which are sent to homes. Groups hosting screening events may also order them.

In the U.S., uptake also improved after cancer agencies brought in self-collection in low-income areas.

"I think we have a chance to actually eliminate a cancer," Ogilvie said. "The fact that we have a screening tool that is even better, that can allow us to identify precancerous lesions earlier, get folks in treatment and prevent these unnecessary deaths, I think is incredibly exciting and motivating."