Self-Sampling Devices for HPV Testing: A Tool to Improve Cervical Cancer Screening

Human papillomavirus (HPV) is a common infection of the reproductive tract. Approximately 97% of cervical cancer cases are attributed to 12 strains of HPV, and 2 specific strains cause 70% of cervical cancer cases. Each year, around 1,300 women across Canada will be diagnosed with cervical cancer and an estimated 400 will die from it. The current practice for primary screening for cervical cancer is the Pap test to detect abnormal cells in the cervix that could become cancerous. Pap tests must be conducted in a clinical setting such as a family doctor’s office or a medical clinic.

In a 2021 Horizon Scan, completed in collaboration with the Canadian Partnership Against Cancer (CPAC), CADTH examined the available evidence on the use of self-sampling devices for HPV testing. Instead of a health care professional collecting the sample, people can use the self-sampling device to collect the sample themselves at home or at a doctor’s office.

Evidence presented in the Horizon Scan report indicates that self-sampling is generally as accurate a method as clinician-collected sampling for HPV testing. The report’s findings are promising because they contribute to the progress of Canada’s action plan to eliminate cervical cancer in our country by 2040. Working with partners, CPAC aims to achieve this goal through 3 priorities: increasing HPV vaccine immunization rates, using HPV testing for primary screening, and improving follow-ups of abnormal screening results.

The Action Plan outlines several priorities specific to First Nations, Inuit, and Métis communities, including Peoples-specific self-determined care and culturally appropriate care closer to home. Specifically, HPV self-sampling can support Peoples-specific priorities as well as the HPV testing for primary screening priority to eliminate cervical cancer.

The Horizon Scan also provides valuable information for Canadian provinces and territories working to implement pilot programs to evaluate the role of HPV self-sampling tests as part of their cervical cancer screening programs. A recent pilot study from Manitoba showed that mailing self-sampling kits improved screening participation in unscreened, nonresponder women within an organized screening program.

Self-sampling devices for HPV testing may be particularly beneficial for people who face barriers to traditional screening such as lack of access to a primary care provider, including distance or lack of transportation, paid time off from work, and/or childcare, or people who may have a history of trauma. Cervical cancer cases are also higher in certain populations, such as people living in rural or remote areas, people with low income, and First Nations, Inuit, and Métis. Culturally safe cervical cancer screening programs offering HPV self-sampling tests could help close the gap in cervical cancer screening in these populations.

“Shifting from Pap tests to HPV tests is crucial to advancing the goals of Canada’s action plan to eliminate cervical cancer and achieving equity of access to cervical cancer screening,” said Erika Nicholson, Vice-President, Cancer Control at CPAC. “Self-sampling is an important strategy to help us reach the goal of screening 90% of eligible individuals with an HPV test by 2030. Self-sampling for HPV means more people in more locations, including rural and remote communities or people without a primary care provider, will be able to access cervical screening. It also provides people with another way to be screened at a time and in a setting that is most comfortable for them.”

Since HPV self-sampling is generally as accurate as clinician-collected sampling for HPV testing and has had favourable uptake by study participants, these devices could increase participation in cervical cancer screening programs. HPV self-sampling is also more cost-effective compared with traditional testing.

Want to learn more about HPV self-sampling tests? Read CADTH’s full report: Self-Sampling Devices for HPV Testing.