Dr. Jones: If you could do your PAP smear at home, would you be more likely to do it? This is Dr. Kirtly Jones from Obstetrics and Gynecology, at University of Utah Health, and this is about home testing on The Scope.
Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.
Dr. Jones: Your trip to your primary care clinician for screening tests such as PAP smears and screening for sexually transmitted diseases is not exactly what most women consider a fun time out from their work and home responsibilities. Although a half hour wait, at least, in the clinic does offer the opportunity to review magazines that are about a year old, catch up on whatever the Kardashians are doing and revealing, pick up some recipes that don't go out of date and watch other parents' parenting styles.
However, when you consider that you had to take a half day off work or get child care unless you want to watch people like me to watch your parenting style, maybe drive more than 10 miles, and then there is parking many women just don't do it. What if you could do some of this testing at home, without the gown, the table, the stirrups, and the speculum? Would you do it?
Well, let's talk about PAPs first. The PAP test is a screening test for cervical cancer that involves collecting cells from the cervix to look for precancerous or cancerous changes.
Over the past several decades it's become increasingly clear that cervical cancer is associated with and probably caused by a sexually transmitted virus. The virus, the human papillomavirus, comes in a lot of different types. Some types don't do anything that we know of, some cause venereal warts, and some types cause cancer. Oral, anal, penile, rectal, and cervical cancer are associated with HPV, and cervical cancer is the most common. The PAP smear as originally designed doesn't test for HPV, just for the abnormal cells.
The current guidelines are that young women should start testing at 21, and currently, the guidelines suggest that it should be the PAP test, the ones that collects cells from the cervix, with the stirrups, and the speculum, and the collection of cells. This is for the first PAP smear, and testing should be every three years if no problems are found. At some point, and the guidelines are changing, you can choose to change to just doing the HPV test, the test for the virus if you haven't previously had any precancerous cells found.
After age 30, you can get a PAP or just the HPV test looking for the dangerous kinds of HPV every 3 years. Or if you can do both the PAP and the HPV, and if they're negative, you only have to test every 5 years. But remember, if you just do the HPV test and it shows you have a dangerous virus, then you have to go see the doctor.
Now, the HPV test doesn't need the stirrups, the table, or the speculum. All of us health clinicians still do it in the office. By the way, the good news for all my ladies of a certain age, if you haven't had an abnormal PAP in the past, after 65 you don't need cervical cancer screening anymore.
Now what about the home test? HPV virus is shed into the vagina and can be found in vaginal fluids and cells. Numerous studies have found that different collection tubes put in the vagina by patients can collect fluids just about as well as can be done in the clinic. These studies have been done all over the world in Sweden, U.S., Australia, and they all show that women can follow the directions and do the test effectively.
One study in Sweden looked at a total of about 4,060 women, 39 to 60 years of age who had not attended PAP smear screening for 6 years or more. These women were randomized to two equal groups. A study group was offered to the self-sample test at home, and the other group was recommended to attend PAP smear screening in the clinic. Well, the participation rate was about 40% in the self-sampling group and only about 10% in the invited-to-go-to-the-clinic group. These ladies who hadn't had a PAP smear for over six years really aren't a compliant bunch of women, let me tell you. Anyway, the home test not only was done more frequently, but it revealed a higher percent of women who were then found to have pre-cancerous conditions of the cervix. So it was done well, by women, more commonly than an offer to go to the clinic, and it had more accurate results.
Okay, well, what about here in the U.S.? There are a number of tests available on the market, UDo, SoloPap, Eve Kit, myLAB. They cost from 79 to 140 bucks. The labs may also offer a kit that does screening for gonorrhea and chlamydia, or other sexually transmitted diseases. The tests offered usually give you result in about a week. If you have an abnormal test, the lab will give you recommendations for follow-up. You need to find a real clinician and have a PAP test with a table and the stirrups and the speculum. Some offer online counseling.
Now, some problems. Number one, the FDA has approved the lab test for the screening for the HPV virus in the lab, but probably has not yet approved the home testing part of the process. It's approved in other countries and may be approved here in the U.S. later. Number two. When you order your own test, your insurance won't probably pay for it. Of course, under the Affordable Care Act, most insurances cover recommended health care screening for women without a co-pay. However, if you don't have insurance or if Congress changes the Reproductive Care part of the Affordable Care Act, it might be cheaper just to pay for it.
And number three the biggest problem is justice, medical inequality. Most women who get cervical cancer have not been screened anytime recently. Cervical cancer disproportionately strikes poor women. They either don't have coverage, or if they do, they can't afford to miss a day's work or pay for child care. Or they don't even know about the risks and screening tests, or they have so much on their plate that getting routine health care just isn't really part of it. If women who need the PAP smears most don't get them, how will they afford to be able to pay for a self-test?
The social justice ideal, and I just invented this, would be for clinics to have free boxes of the self-test at the front desk along with condoms, and someone could just pick one up and drop it off with their contact info. How great would that be? Anyway, so the home diagnostics business is booming, and it started with the home pregnancy test. It has moved on to letting you test your entire genome. Well, that is great. In principle, home testing for the HPV virus for cervical cancer is a great idea. Women can do it correctly and the test works. The devil is in the details. And thanks for joining us on The Scope.
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