Can an at-home test replace a Pap smear for cervical cancer screening?

Maybe you have avoided doing a Pap smear (Pap test) for cervical cancer screening for years even though you know it saves lives. Many women do, for a variety of reasons. Some may feel uncomfortable with pelvic exams or face barriers related to past trauma. And for many, having access to and getting time to see a healthcare professional is difficult.

You might be surprised to learn that several new options make it simpler. It’s now even possible to collect a sample yourself for screening.

There are two Food and Drug Administration (FDA)-approved self-collection tests for HPV — the virus that causes nearly all cervical cancers — that you can do in a healthcare setting like a healthcare clinic, lab, pharmacy or doctor’s office, without needing to have a pelvic exam. There is also a recently approved home device to collect a vaginal sample for testing.

You may hear this new test referred to as an “at-home Pap smear,” although that’s not really accurate. During a Pap test, a healthcare professional inserts a speculum and scrapes cells directly from the cervix. The cervix is attached to the lower part of the uterus and opens into the vagina. The collected cells are tested for cancer and precancer, and often also for HPV. The new test is different — it is an at-home test to check for the presence of HPV.

How do HPV self-swab tests work?

With the HPV self-collection tests, you use a swab to collect your own vaginal sample, says Kathy L. MacLaughlin, M.D., a family medicine specialist at Mayo Clinic in Minnesota. The sample is then sent to a lab that tests the vaginal cells for high-risk types of HPV, the types that are most likely to cause cancer.

The two tests that you can use on your own in a healthcare clinic or doctor’s office are:

• Roche cobas HPV test (with Copan swab or Evalyn brush).
• BD Onclarity HPV Assay (with Copan swab).

 “They are not yet approved for at-home use,” Dr. MacLaughlin says.

At-home Pap smear alternative

The first FDA-approved HPV self-collection test you can use at home is from the Teal Health company. This test uses a device called the Teal Wand to collect a vaginal sample.

Like the clinic-based self-collection tests, the Teal Health test examines cells from the vagina — not directly from the cervix, as happens with a Pap smear. After collecting the sample, the user mails it back and receives results, follow-up recommendations and referrals if needed through a phone app or teleheath visit.

Who can benefit from HPV self-collection tests?

HPV self-collection tests are intended for people at average risk of cervical cancer who don’t have any symptoms. Some women may be told by their healthcare team that they are at higher risk and need a Pap test or more-frequent screening. Among the factors that increase risk are having a history of cervical changes detected by a previous Pap test, irregular bleeding, HIV or a suppressed immune system, for example.

You also should avoid the self-collection test if you’re currently menstruating or you have used any vaginal products — such as moisturizers, lubricants or spermicides — in the past couple of days.

But for many, self-collection offers a flexible and convenient option. “We have a lot of folks who come in for other reasons — diabetes, ear pain — and we notice they’ve never had (cervical cancer screening) or they’re long overdue,” Dr. MacLaughlin says. “They can collect the self-test while they are in the office.”

Pros and cons of at-home HPV testing

At-home testing offers privacy and convenience, so people can screen without visiting a doctor’s office. According to Teal Health’s website, tests using the Teal Wand have been shown to detect cervical precancer 96% of the time, which is on par with samples collected by a healthcare professional.

However, Dr. MacLaughlin has some reservations about the at-home test, especially when it comes to follow-up care. If you do a self-collection test in a healthcare clinic or other healthcare setting, your healthcare professional knows you did it and to expect the results. But with an at-home test, you need to make sure your healthcare professional knows you did it (and when). And the results of the at-home test are not integrated automatically into your medical records, which can affect follow-up care.

“HPV screening is not quite like taking a home COVID test,” Dr. MacLaughlin says. “We need to coordinate and provide access to next steps in the cancer prevention continuum such as a follow-up Pap, colposcopy or precancer treatment.”

If you do opt for at-home testing, Dr. MacLaughlin strongly recommends keeping your gynecologist, primary care or another healthcare professional in the loop. “Take this to your primary care to review results. Make sure your record is updated,” she says.

Is HPV self-collection right for you?

While not many healthcare clinics or doctors’ offices offer it yet, Dr. MacLaughlin believes growing awareness and acceptance of HPV self-collection will make cervical cancer screening more accessible, especially for those who face obstacles such as discomfort, a trauma history, embarrassment or scheduling limitations.

She also believes home-based tests will eventually integrate more smoothly with clinic-based lab systems, which could ensure better follow-up. “I hope that in the near future we see home-based approval for the systems that already have clinic-based approval, as they are integrated into the health monitoring and the lab ordering process,” she says.

In the meantime, if you’re interested in self-collection, ask your healthcare professional if it’s available and right for you. If you choose a home test, make sure you understand what steps you may need to take if the result is positive, and let your healthcare team know the results.

Overall, Dr. MacLaughlin is excited by what self-collection could mean for many people. “It’s not replacing current options — it’s expanding the menu of screening options,” she says. “And really empowering those who have barriers.”