Studies have shown that human papillomavirus (HPV) infection—especially with high-risk variants such as HPV16 and HPV18—is the primary cause of cervical cancer, accounting for about 95% of all cases. Although cervical cancer screening through Pap smear tests can detect the presence of precancerous or cancer cells, and has led to significant reductions in cervical cancer incidence, screening rates among Asian American women are low—just 70%—compared with non-Hispanic White women (81%).
The results from a randomized controlled study showed that when given the option to collect their own vaginal sample for HPV testing, in conjunction with a community educational workshop on cervical cancer, screening rates for the disease increased among Asian American women. The findings demonstrate that self-sampling for HPV testing may prove to be a successful strategy for increasing participation in cervical cancer screening among populations living in underresourced communities. The study was presented by Fang et al during the 18th AACR Conference on The Science of Cancer Health Disparities (Abstract B040).
Study Methodology
The researchers enrolled 1,140 Asian American women (aged 30–65 years) who were not up to date with recommended cervical cancer screening guidelines. Nearly all participants—99.8%—were not born in the United States, and 47% had never received a Pap smear test. More than 55% of the study participants had a high school education or less.
Participants were randomly assigned to either participate in a community educational workshop on cervical cancer, including referrals to sites with free or low-cost Pap test screening (control condition, n = 588) or to attend the same workshop plus receive an HPV self-sampling kit (intervention condition, n = 552). The kit included a U.S. Food and Drug Administration (FDA)-approved device (brush) for the self-collection of cervicovaginal samples, along with detailed instructions on how to collect a sample and return it to the study staff. All materials were available in English, Korean, Vietnamese, and Chinese.
Key Results
At 6 months after the workshop, the researchers assessed the proportion of participants who completed a cervical cancer screening, either through a Pap test or through a self-collected sample for HPV testing. They found that a majority of participants in the intervention group (87%) returned a self-collected sample for HPV testing, whereas only 30% of participants in the control group obtained a clinic-based Pap or HPV test.
Among women who completed HPV self-sampling, nearly 10% tested positive for high-risk HPV, with an additional 5% testing positive for low- or intermediate-risk HPV strains. All women who tested positive for high-risk HPV received navigation assistance for follow-up care.
“Although some clinic-based cancer screening interventions can successfully reach underscreened women, various factors such as limited clinic hours, inconvenient locations, and transportation challenges continue to hinder access and screening uptake for many women. This study demonstrates that self-sampling for HPV testing can be a successful strategy for enhancing participation in cervical cancer screening among Asian American women and offers a pragmatic approach for increasing scalability across all populations living in underresourced communities and regions,” concluded the study authors.
Eliminating Cervical Cancer
“Our findings indicate that a targeted, culturally sensitive, convenient, and private option really appealed to women and may help us get closer to the ultimate goal of eliminating cervical cancer,” said presenting author Carolyn Fang, PhD, Associate Director for Population Science and Professor in the Cancer Prevention and Control Program at Fox Chase Cancer Center—Temple Health, in a statement. “By increasing women’s familiarity and comfort with testing, we hope to empower women to seek regular gynecologic care, as well as reduce their anxiety and embarrassment associated with these procedures.”
Disclosure: Funding for this study was provided by the National Cancer Institute.
