At-Home HPV Testing Kits Could Close Cervical Cancer Screening Gaps

A study out of the UNC Gillings School of Global Public Health is bringing cervical cancer screenings to the forefront, outlining key strategies that could help get women in for care and close care gaps.

The study, completed in partnership with the UNC Lineberger Comprehensive Cancer Center, showed that a program for at-home HPV testing kits helped get more patients in for in-person cancer screening care.

These findings come as the US continues its work to close care gaps, which were problematic before 2020 but grew starker after the pandemic. In February 2023, data in the Epic Health Research Network showed that cancer screening rates tanked between January 2018 and December 2022.

For cervical cancer in particular, the UNC researchers pointed out that around a fifth (22 percent) of eligible patients are overdue for a cervical cancer screening. This is in the context of the 14,000 women who will be diagnosed with cervical cancer in a given year and the 4,300 who will die from it.

These most recent findings provide a glimmer of hope as healthcare organizations determine strategies to balance bringing healthcare to patients in their homes and engaging them in in-person care when necessary.

“My hope going into this study was that mailing kits for home-based collection might increase cervical cancer screening, but we were thrilled to find a nearly two-fold increase in screening uptake,” UNC Lineberger’s Jennifer S. Smith, PhD, MPH, professor of epidemiology at UNC’s Gillings and corresponding author of this study, stated publicly. “Many hadn’t engaged in the screening system for a while and getting the kit to their homes helped break down a fundamental barrier.”

The researchers zeroed in on low-income women, enrolling 665 women with either Medicare or Medicaid coverage into the study. Participants were considered as having cervical cancer screening care gaps, with all neither having a pap test in four years nor a high-risk HPV test in six years, the researchers said.

Two-thirds of participants received an at-home HPV testing kit along with assistance in scheduling an in-person cervical cancer screening, while the remaining control group received the scheduling assistance.

Overall, getting that at-home test made all of the difference in scheduling an in-person appointment.

Three-quarters (78 percent) of women receiving an at-home HPV testing kit returned it, and 72 percent went on to schedule an in-person visit. That’s compared to 37 percent of those receiving scheduling assistance alone. What’s more, only a small proportion had incidents using the at-home testing kit and no participants withdrew from the study due to injury.

The program’s success rested largely with the at-home HPV testing, the researchers said. Letting participants use the test kit at home and providing the option to self-administer made the screening more accessible and therefore increased engagement, according to Noel T. Brewer, PhD, a Gillings Distinguished Professor in public health and UNC Lineberger member.

“Home screening for cervical cancer puts women in control. Most can avoid having to go to a doctor’s appointment,” Brewer, also a study co-author, said in a press release. “These at-home kits can better reach people without access to screening, who are embarrassed by a cervical exam, or whose religious beliefs include modesty.”

These results were consistent across age, race/ethnicity, time since last screening, Medicare versus Medicaid coverage, and educational attainment. That is crucial considering the focus on traditionally underserved populations, according to Smith.

“We believe our results are applicable to low-income, under-screened women across the United States,” Smith said.

The next step is to roll this program out more broadly using health data analytics to detect all individuals who are behind on cervical cancer screening, Smith added.

“We’re now working with clinical partners to identify women who might be overdue for screening through electronic medical records,” Smith said. “We hope to provide the option of either mailing them a self-collection kit to use at-home to mail back to us or hand a kit directly to them when they come into clinics for other services with the vision to eventually make self-collection a regular clinical provision.”