Breaking down barriers: How the HPV self-swab testing can improve cervical cancer screening accessibility

Hunter Holt; Katherine Craemer; Kelley Baumann; Emilie Glass-Riverosx; Monica Nava Frenier

doi:10.1370/afm.22.s1.6115

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Expanding access: community-based HPV self-testing for cervical cancer prevention in low-to-middle-income countries
Laila Afroze and Md Sazedur Rahman

Published on: 20 November 2024

Published on: (20 November 2024)
Page navigation anchor for Expanding access: community-based HPV self-testing for cervical cancer prevention in low-to-middle-income countries
Expanding access: community-based HPV self-testing for cervical cancer prevention in low-to-middle-income countries
Laila Afroze, Researcher, Statistics Discipline, Khulna University, Khulna-9208, Bangladesh.
Other Contributors:
Md Sazedur Rahman, Researcher
Dear Editor,

We commend Holt et al. for their insightful study highlighting the feasibility and acceptability of self-collected HPV testing among Black and Latinx women in Chicago [1]. Their findings underscore the promise of self-swab testing as a transformative, patient-centered strategy to address barriers to cervical cancer screening.

Cervical cancer disproportionately affects women in low-to-middle-income countries (LMICs), largely because traditional screening methods like Pap smears require clinical infrastructure and trained healthcare professionals, which are often scarce in these settings [2-5]. Other barriers to HPV screening include limited access to screening facilities, sociocultural stigma, and financial constraints [2-5]. Self-collected HPV testing presents a transformative opportunity to overcome these barriers [1,6,7]. By enabling women to collect samples privately and at their convenience, this method can significantly increase participation rates in cervical cancer screening programs [7].

Moreover, the integration of self-swab testing into community-based public health initiatives could enhance awareness, empower women to take control of their health, and reduce the reliance on overburdened healthcare systems. Programs combining self-swab testing with educational campaigns and mobile health technologies could further strengthen uptake, particularly in rural and underserved areas.

As Holt et al. suggest, ensuring affordability...
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Dear Editor,

We commend Holt et al. for their insightful study highlighting the feasibility and acceptability of self-collected HPV testing among Black and Latinx women in Chicago [1]. Their findings underscore the promise of self-swab testing as a transformative, patient-centered strategy to address barriers to cervical cancer screening.

Cervical cancer disproportionately affects women in low-to-middle-income countries (LMICs), largely because traditional screening methods like Pap smears require clinical infrastructure and trained healthcare professionals, which are often scarce in these settings [2-5]. Other barriers to HPV screening include limited access to screening facilities, sociocultural stigma, and financial constraints [2-5]. Self-collected HPV testing presents a transformative opportunity to overcome these barriers [1,6,7]. By enabling women to collect samples privately and at their convenience, this method can significantly increase participation rates in cervical cancer screening programs [7].

Moreover, the integration of self-swab testing into community-based public health initiatives could enhance awareness, empower women to take control of their health, and reduce the reliance on overburdened healthcare systems. Programs combining self-swab testing with educational campaigns and mobile health technologies could further strengthen uptake, particularly in rural and underserved areas.

As Holt et al. suggest, ensuring affordability and insurance coverage is paramount. For LMICs, this necessitates international collaboration to subsidize costs, expand insurance schemes, and leverage donor support. Additionally, tailoring the intervention to the local context, as demonstrated in their Chicago study, will be essential for success.

We urge policymakers, healthcare providers, and global health organizations to prioritize the scaling of self-collected HPV testing in LMICs as a critical step toward equitable cervical cancer prevention. Such efforts align with the WHO’s Global Strategy to Eliminate Cervical Cancer and represent a pivotal opportunity to bridge gaps in screening and reduce the global cervical cancer burden [6].

References

1. Hunter Holt, Katherine Craemer, Kelley Baumann, Emilie Glass-Riverosx and Monica Nava Frenier. Breaking down barriers: How the HPV self-swab testing can improve cervical cancer screening accessibility. The Annals of Family Medicine. 2024, 22 (Supplement 1) 6115. https://doi.org/10.1370/afm.22.s1.6115

2. Singh D, Vignat J, Lorenzoni V, Eslahi M, et al. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. The Lancet Global Health. 2023; 11(2):e197-206. https://doi.org/10.1016/S2214-109X(22)00501-0

3. Afroze L, Rahman MS. Community-based interventions to reduce cervical cancer in low-and middle-income countries: a call to action. International Journal of Gynecologic Cancer 2024:ijgc-2024. https://doi.org/10.1136/ijgc-2024-006188

4. Petersen Z, Jaca A, Ginindza TG, et al. Barriers to uptake of cervical cancer screening services in low-and-middle-income countries: a systematic review. BMC Women's Health 2022;22:486. https://doi.org/10.1186/s12905-022-02043-y

5. Rahman M, GÜLTEKİN M, Lassi Z. Effective approaches towards eliminating cervical cancer from low-and middle-income countries amid COVID-19 pandemic. International Journal of Gynecological Cancer. 2020;30(11). https://doi.org/10.1136/ijgc-2020-002013

6. Sy F, Greuel M, Winkler V, Bussmann H, Bärnighausen T, Deckert A. Accuracy of HPV testing on self-collected and clinician-collected samples for different screening strategies in African settings: a systematic review and meta-analysis. Gynecologic Oncology. 2022;166(2):358-68. https://doi.org/10.1016/j.ygyno.2022.06.012

7. Racey CS, Withrow DR, Gesink D. Self-collected HPV testing improves participation in cervical cancer screening: a systematic review and meta-analysis. Canadian Journal of Public Health. 2013;104:e159-66. https://doi.org/10.1007/BF03405681
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Competing Interests: None declared.