Mail-in HPV screening kits help prevent cervical cancer in hard-to-reach women

A new pilot study has concluded hard-to-reach women are more likely to take preventive steps against cervical cancer when they’re mailed at-home human papillomavirus (HPV) screening kits as a first step.

The Health Outcomes through Motivation and Education (HOMES) Project, spearheaded by Ohio State University associate professor Paul L. Reiter, PhD, MPH, enrolled 103 women living in Appalachian Ohio who were between 30 and 65 years old and hadn’t received a Pap smear in at least three years. Around half of the women hadn’t undergone Pap testing in more than five years.

“There’s a lot of interest in exploring more widespread use of these tests in the U.S., particularly to increase screening rates among women who aren’t getting regular care,” Reiter said in a release. “The reality is that many of these women are not coming in regularly anyways. We think these at-home tests can help open the door to follow-up visits to a healthcare provider.”

Women who participated in the HOME project were contacted about their interest before they were sent initial HPV screening kits. Each DIY test included self-test instructions from either the device manufacturer (control group) or HOME researchers, who included photos and definitions (intervention group).

Eighty women—78 percent of the pool—returned their screening kits to the researchers for testing. Return rates were similar between randomized intervention and control groups, and among those who returned their results, 26 percent had an oncogenic HPV type detected in their sample.

“The return rate was so much higher than we expected,” Reiter said. “We thought maybe 30 or 40 percent of the women would send the tests back,  based on experiences in other countries.”

He said his team partnered with federally qualified health centers in southeast Ohio to digest the study’s results. Women who sent in a test were notified when their results were available and encouraged to make an appointment with their local health clinic to receive and talk over the numbers. Just 11 percent of women ended up having a follow-up Pap test to screen for cervical cancer, and additional testing was most common among those with the highest-risk HPV types detected in their sample.

At-home HPV tests are already used in other developed countries like Australia and the Netherlands, but they aren’t approved or recommended for cervical cancer screening in the U.S. Instead, the norm for early detection of cervical cancer is either a Pap smear or a colonoscopy, followed by a body CT, body MRI, x-ray or PET scan in the case of questionable findings.

Reiter said the HOME study’s preliminary results are promising, but the trial was limited in the fact that researchers gauged participants’ interest in at-home HPV kits prior to sending them out. He said his team also wants to address the low drop-off rate of follow-up Paps.

“We appreciate the importance of figuring out how to get these women to come to the clinic,” he said. “One of the things that we would need to think about moving forward with our research is minimizing the drop-off we saw. Ideally, this testing should be a springboard for getting women into the healthcare system.”

Reiter and colleagues’ work was published Nov. 19 in Sexually Transmitted Diseases.