Can at-home tests reduce cancer deaths?

This undated microscope photo made available by the Centers for Disease Control and Prevention shows the results of a Papanicolaou test, or Pap test, with a positive indication for the presence of uterine cervical adenocarcinoma, classified as Stage-III. According to a study published in the journal JAMA Oncology on Thursday, May 5, 2022, researchers found that overall uterine cancer death rates in the U.S., increased by 1.8% per year from 2010 to 2017. (CDC via AP)

(NewsNation) —  Up to 90% of cervical cancers are curable if they’re caught early, but the women most at risk of dying are also the ones most likely to skip a life-saving screening, largely due to limited healthcare access.

That distinction is why death rates have stagnated after decades of progress, according to Dr. Vikrant Sahasrabuddhe of the National Cancer Institute.

“Some women don’t go to the doctor every year on a regular basis, or there’s just no provider in the town where you live,”  Sahasrabuddhe said. “We wanted to fill this gap.”

The solution was at-home tests. They function much like COVID-19 nasal swab tests for the cervix and have been used to reduce disparities around the world, but are not yet available in the U.S.

Sahasrabuddhe’s team at the National Cancer Institute is working on a project to prove that self-sampling tests can work for at-risk women across the U.S. The results may lead to new breakthroughs in cancer screenings.

Why focus on cervical cancer? 

Cervical cancer screenings have progressed immensely over the past decades, saving hundreds of thousands of lives a year. 

And while a lot of progress has been made internationally, more than 14,000 Americans are diagnosed annually, and over half have never had a cervical cancer screening or not frequently enough. The majority are patients living in rural areas, in communities of color, or who have lower incomes.

“We haven’t really seen the same levels of decline in the last two decades or so,” Sahasrabuddhe said. “It’s really still a very big access issue.”

That’s where new technology can make a big difference. 

Am I qualified to perform it?

The mainstay for cancer screenings are annual pap smears, which require a pelvic exam performed by a doctor. But the at-home tests may help bridge the gap.

Pap smears test looks for cancerous cells and requires expertise in collecting and reading a sample, Sahasrabuddhe said.

“Getting this relatively simpler process (is) not the most preferred process by anybody… because it does involve a pelvic exam,” he said.

Comparatively, the at-home tests simply identify the presence of the HPV virus, which causes about 90% of cervical cancers. The results are less subjective and require less expertise to read, Sahasrabuddhe said. 

And because cervical cancer is slow-moving, finding the virus means doctors can prevent cancer cells from spreading before it starts. 

How does an at-home test work?

Women collect the sample themselves using a swab that’s then broken off into a vial of liquid or preserved in some way.

Those are mailed off to a lab, and follow-ups happen over the phone. A patient only comes into a doctor’s office if it’s positive. 

Studies have shown women are significantly more likely to do a screening if they can do it at home. And early research indicates the results are just as accurate as going into a doctor’s office.

One analysis of more than 3,000 women found that 93% were willing to do a self-screening, stating these tests are “convenient, increases women’s sense of privacy, improves access in remote areas, decreases stigma and embarrassment, and reduces the potential financial … and logistical burden.”

Why aren’t they already available in the U.S.? 

It’s important to note that most of the research has been done in other countries, Sahasrabuddhe said, and the U.S. health system is very different. 

“There are some qualitative differences between how our populations are,” he said, including wider income disparities, and more cultural and racial diversity. “Whether or not this particular approach will work for everybody, I don’t think we have very clear-cut evidence.”

There are several companies that are developing these tests, but there haven’t been enough large clinical trials for the FDA to give approval. That’s where the NIC comes in, Sahasrabuddhe said. 

Starting this spring, they’ll begin a large clinical trial covering women from all walks of life: urban and rural, insured and uninsured, all racial groups and from every socioeconomic class.

By helping coordinate the studies, Sahasrabuddhe’s team hopes the women most likely to die of cervical cancer will be able to access these tests sooner.

What’s next? Could other cancers be caught this way?

There are big implications for cancer screening if and when the at-test model is proven in the U.S., Sahasrabuddhe said.

For example, HPV can also cause other cancers throughout the body, and hepatitis C screenings can help prevent liver cancer. 

From a public health perspective, HPV screenings could be bundled with other at-home screenings that people don’t get often enough — like for highly deadly colon cancer. Community clinics or primary physicians could even stock these kits in their offices, making cancer screenings a normal part of checkups.

“We hope this will open up avenues for screening for the most at-risk population, the underserved and under-screened women,” Sahasrabuddhe said. “The FDA should consider this as an approach that actually changes the landscape of screening.”


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