HPV Self-Collection: A New Tool for Cervical Cancer Screening in Primary Care

The FDA approved HPV self-collection tests for use in health care settings, marking a shift in cervical cancer screening strategies. While clinician-collected Pap smears with or without HPV testing remain the gold standard, self-collection may offer an important alternative for patients who face barriers to traditional exams.

In this interview with Patient Care^®, Ada Stewart, MD, a board-certified family physician and past president of the American Academy of Family Physicians, explains which patients may benefit most from HPV self-collection and how primary care physicians can integrate this option into practice. From addressing the needs of patients with trauma histories or those who are gender diverse to clarifying the limitations of self-collection, Dr Stewart emphasizes that the ultimate goal is ensuring no opportunities are missed to detect precancerous changes or cervical cancer early.

The following transcript has been lightly edited for style and flow.

Ada Stewart, MD: As a family physician, we want to have all the options available to ensure we don’t miss opportunities to screen. Of course, we encourage the gold standard, which is the clinician-collected cytology Pap smear, ideally with HPV testing.

I care for individuals who have been traumatized, as well as patients who are gender diverse or trans male. For those patients, it’s about having a conversation. We know there are some limitations to self-collection, but for patients who feel it is their only option, we need to make sure they understand that if there is an abnormality, they will still need to return for a speculum exam performed by the clinician.

Self-collection gives us another option—another tool in our toolkit—to help ensure everyone gets screened and that we don’t miss opportunities to prevent cervical cancer. For me, the individuals for whom this may be an option are those who refuse to have any type of exam. The FDA approved this for average-risk patients, but assessing risk is difficult. Patients often don’t know their risk, and even we as clinicians may not be able to fully assess it. That’s why it’s incumbent upon us to make sure the best test is the one that is offered, the one most likely to identify precancers and cancers in our patients.