Cervical Cancer Screening At Home
I recently had my annual gynecologic exam, which for me also ends up being a time to catch up with a colleague and friend.
I wasn’t due for cervical cancer screening this year, but if I had been, could I have done it at home?
The answer is (almost) yes.
What is cervical cancer screening?
Screening is a term used to describe tests that are performed to detect disease early. They often are an initial step in detecting and diagnosis disease, but they are not diagnostic themselves. That means if a screening test results are abnormal, additional testing is needed to make a diagnosis.
The cervix is part of the uterus. If the uterus is the head, the cervix is its neck. This is the part that dilates in labor to allow a baby to move from the uterus and through the vagina to be delivered.
Cancer of the cervix is, like any cancer, cells that have exited a normal cell cycle and grown out of control.
Cervical cancer is caused by the HPV virus, the most common sexually transmitted infection of which there are hundreds of strains. Some of these strains, namely 16 and 18, are highly associated with cervical cancer.
Initial cervical cancer screening efforts started with the Pap smear, George Papanicolau is dubbed to have been the discoverer (See “Pap” in his name).
What benefits has cervical cancer screening had?
The number of cervical cancer cases and deaths from cervical cancer have dropped by about half in the last 40 years.
Again, with the goal of a screening test being early detection, cervical cancer in early stages is a treatable cancer with removal of the cervix (and often uterus entirely).
How is cervical cancer screening performed?
The initiation and timing of screening will be discussed below.
As for the physical exam where cervical cancer screening is obtained, the Pap (with or without HPV testing) is usually collected during a speculum exam.
To be clear, the speculum exam itself and the Pap are not the same.
The speculum exam is when the duckbill (speculum) is inserted into the vagina and opened in order to look in the vagina and at the cervix for a visual inspection. Cervical cancer screening may or may not be performed during this time of exam. If it is, it involves various types of brushes or wands that collect cells from the cervix and are sent to the lab.
Speculums used to be metal (and often cold). Some offices had warm metal speculums. Now, most are plastic and disposable.
What are the current recommendations for cervical cancer screening?
This has become so complex that now Paps are performed in conjunction with HPV testing (particularly for strains 16 and 18), or HPV testing can be performed first. With the exception for immunosuppressed individuals, screening starts at age 21.
In contrast to when I initiated screening, the Pap doesn’t get performed annually anymore. The interval depends on which test was performed and the patient’s age. A summary of guidelines is pictured below.
The management of abnormal results is now so convoluted that we don’t know off the top of our heads. I was actually worried about this before taking my oral board exam to become a board-certified obgyn. I thought I could be given a hypothetical abnormal Pap result and be asked what I would do next or what her percent chance of severe pre-cancer cells would be. The reality is, we use a mobile app from the ASCCP where we input the patient’s age and result and it spits out the next step in management. We won’t discuss abnormal results in any more detail, but suffice it to say it’s incredibly complex.
What is the future of cervical cancer screening?
While many doctors individually and the medical community collectively often resist new ideas, technology, and relinquishing services (and therefore billing), I am enjoying the advances in women’s health technology.
For background, it wasn’t until the 1970s that women were able to perform urine pregnancy tests on themselves at home. Until that point, they had to get a pregnancy test performed in an office.
Other tests that can be performed at home are:
Urinalysis
Sexually transmitted infections
Strep throat tests
Colon cancer screening
Now here we are, a month away from ordering cervical cancer screening online to be performed at home.
A company called Teal Health will be shipping their device to customers starting next month (June, 2025).
This is a wand inserted into the vagina and detects the HPV virus. The collected sample is sent to the lab and the patient later receives the result and interpretation through their interface.
My take:
I see the overwhelmed and understaffed medical resources on a daily basis in addition to the patient apprehension about exams, particularly invasive ones. I think this is an excellent way to empower patients with their own health and perform necessary tests outside of a hospital system.
Resources:
Some of the information contained in this article is the result of my training, medical knowledge, and personal experience without a specific source to be cited.
This is not medical advice. This is for educational purposes only.
https://www.testing.com/articles/point-of-care-testing/
https://pmc.ncbi.nlm.nih.gov/articles/PMC4613936/