The landscape of cervical cancer screening is on the cusp of significant change, driven by the increasing adoption of self-collected human papillomavirus (HPV) tests. These tests offer a more accessible and convenient screening method, particularly for underserved populations. Recent guidelines and studies suggest that self-testing could lead to earlier detection, improved risk stratification, and more efficient resource allocation in cervical cancer prevention.
Self-Screening to Boost Case Detection
The US Preventive Services Task Force (USPSTF) has proposed new guidelines incorporating self-collected HPV tests for cervical cancer screening. This update recommends that women aged 30-65 can use self-collected samples for HPV testing, a method confirmed to be as accurate as clinician-collected samples. This approach is expected to increase screening rates, especially among women facing barriers to traditional screening methods. GlobalData epidemiologists forecast approximately 13,800 diagnosed incident cases of cervical cancer in women ages 18 and older in the US in 2025, growing to about 14,300 cases by 2030. However, with the implementation of self-screening, these numbers are anticipated to rise even further due to increased case identification.
Risk Stratification for Optimized Management
Research from Karolinska Institutet and Queen Mary University of London, published in PLOS Medicine, introduces a novel approach to risk stratification based on HPV self-test results. The study, involving 855 British women with positive HPV self-tests, found that analyzing HPV variants and viral load (measured by cycle threshold, Ct value) could effectively divide women into high, medium, and low-risk groups. Women with HPV type 16 and a low Ct value (<30) had the highest risk of severe cervical precancer or cancer.
Jiayao Lei, assistant professor at Karolinska Institutet, noted that approximately 40% of women in the high-risk group had severe cervical precancer or cancer requiring treatment. The study suggests that this high-risk group should be referred directly for colposcopy. In contrast, over half of the participants were in the low-risk group, with only a 4% probability of severe cervical precancer or cancer within 12 months, suggesting that retesting after 12 months would be a safe approach for this group. The moderate-risk group should be encouraged to get tested by clinicians.
Streamlining Screening in Low-Resource Settings
A significant advantage of this risk stratification method is that it can be performed directly after the HPV self-test, eliminating the need for additional laboratory analyses. Peter Sasieni, Professor at Queen Mary University of London, highlighted the potential benefits for cervical cancer screening in low- and middle-income countries, where resources are often limited.
Future Directions
Future research will focus on large-scale population studies in Sweden to assess the feasibility of incorporating risk stratification into routine screening programs. Researchers also aim to investigate the predictive values of current test results in combination with other markers for HPV-positive women. These efforts are supported by organizations such as the Swedish Cancer Society, Cancer Alliances, Cancer Research UK and the Swedish Research Council.
