By skyforbes 
Transformative advances in prevention and early detection have brought us closer than ever to eliminating cervical cancer. In addition to being highly treatable in early stages, cervical cancer is one of the few cancers that is largely preventable through recommended vaccination and screening efforts. The impact of these efforts has been profound, as rates of cervical cancer incidence and death in the United States dropped by more than half between the 1970s and 2000s. But we’re not at the finish line yet — achieving a future where no one dies of the disease will require continued dedication to timely screening, vaccination, and treatment for all patient populations. By overcoming barriers to access and improving the diagnostic process with innovative screening approaches, we can further reduce the global burden of cervical cancer.
Where screening & prevention efforts have fallen short
Nine of every ten cases of cervical cancer are caused by human papillomavirus (HPV), making HPV screening and vaccination against high-risk strains some of our most impactful tools in combating the disease. Between 2008 and 2022, precancerous cervical lesions decreased by 80% among screened women aged 20 to 24, the age group most likely to have been vaccinated against HPV. Despite these impactful results, HPV vaccine uptake remains relatively limited in the U.S, with less than two-thirds of adolescents aged 13–17 who have received all recommended doses.
HPV screening and Pap testing, which can detect cancerous or precancerous changes in cervical cells, are vital for identifying those at risk of cervical cancer and enabling intervention in its earliest, most treatable stages. However, over half of U.S. women diagnosed with cervical cancer have either never been screened or have undergone infrequent screening. Those diagnosed with cancer at advanced stages also tended to report a longer time since their last screening.
Differences between certain sociodemographic groups are apparent in rates of cervical cancer screening. For example, a 2019 study revealed higher rates of overdue screening in U.S. women without insurance, those in racial/ethnic minority groups, those living in rural areas, and those identifying as lesbian, gay, or bisexual. A more recent study revealed another troubling trend: Overall rates of cervical cancer screening decreased between 2019 and 2022, with rural women particularly impacted. These gaps in screening align with differences in cervical cancer incidence and survival. Black and Hispanic women, as well as women in low-income and rural communities, are most adversely affected by the disease.
Supporting cervical cancer prevention with accessible and accurate screening
While there is no “magic bullet” solution to decreasing the burden of cervical cancer, advances that make regular screening more accessible and patient-friendly are foundational steps in supporting early detection for all women. Identifying solutions requires an understanding of the factors driving disparities in timely screening.
Current Pap and HPV testing procedures, which typically require a pelvic exam to enable a healthcare provider to collect a cervical cell sample, can be inconvenient and stressful. For many people, making and attending a screening appointment is subject to logistical barriers, from difficulty taking time off from work to a lack of transportation. With an average wait time of over a month for an OB/GYN appointment in the US, keeping up with cervical cancer screening can be frustrating or simply inaccessible. The invasive nature of a pelvic exam can also be distressing or uncomfortable for many people, particularly those with a history of sexual trauma, cultural concerns, and disabilities.
Overcoming limited access to cervical cancer screening is a multifaceted issue, but new options for how testing takes place are promising steps forward. HPV self-collection tests, which enable a woman to independently collect their own vaginal sample in a healthcare setting, first received approval from the U.S. Food and Drug Administration in 2024. Developing a new way to gain a vaginal sample without using a pelvic exam represents a significant expansion of accessible screening, as testing for the strains of HPV most likely to cause cancer is now possible in primary care offices, urgent care centers, mobile clinics, and other healthcare settings. Self-collection options enable those who do not want or cannot have a pelvic exam to surmount barriers to cervical cancer screening and take control of their health. However, clinician-collected sample testing remains an option for people who prefer this method or when a pelvic exam is indicated based on reported symptoms.
Further advances in diagnostic technology also support more precise assessment of HPV infection and cervical cancer risk. Although HPV tests can accurately identify high-risk strains of the virus, they do not detect markers of pre-cancer or cancer itself. Dual-stain cytology is a recent innovation that provides an objective, biomarker-based evaluation of HPV infections most likely to progress to cancer. By detecting the co-expression of p16 and Ki-67 within the same cervical cell, an indicator of active HPV-mediated changes in the cells towards precancer and cancer, dual-stain testing distinguishes clinically significant infections from transient ones that may resolve on their own. This helps clinicians determine which patients need immediate follow-up and which can be safely monitored, reducing unnecessary procedures while ensuring timely care for those most at risk.
The future of cervical cancer screening
HPV self-collection testing is poised to drive continued momentum in the fight to eliminate cervical cancer. The evidence thus far demonstrates comparable clinical performance between self-collected and clinician-collected samples for HPV testing, but further assessment will be valuable in developing best practices for clinical integration. In 2024, the National Cancer Institute Cervical Cancer ‘Last Mile Initiative’ launched a multisite clinical trial dedicated to evaluating the accuracy, usability, and clinical efficacy of HPV self-collection testing for cervical cancer screening. The Self-collection for HPV Testing to Improve Cervical Cancer Prevention (SHIP) Trial will enroll participants at 25 diverse healthcare sites across the U.S. to inform further FDA review of self-collection devices. Additionally, a December 2024 draft recommendation update from the U.S. Preventive Services Task Force further emphasized the importance of HPV testing and included self-collected HPV testing as part of its cervical cancer screening guidelines.
By expanding access to cervical cancer screening, particularly for those who face barriers to traditional clinic-based methods, HPV self-collection testing empowers more people to participate in their own care, fostering autonomy and helping to bridge long-standing gaps in access to screenings for all populations. HPV self-collection testing not only enhances early detection of high-risk infections but also aligns with broader public health goals of eliminating the burden of cervical cancer.
As mounting evidence supports the accuracy and reliability of HPV self-collection testing, its adoption within national screening guidelines could help us through the “last mile” of reducing cervical cancer incidence and mortality. HPV self-collection is more than a convenient alternative to traditional testing approaches: It represents a new paradigm of accessible and inclusive screening. While there is much more work to be done in addressing cervical cancer and overcoming persistent disparities for all, diagnostic advances are paving the way for a healthier and more patient-empowered future.
Photo: FotografiaBasica, Getty Images
Carolyn Kay, MD, is an obstetrician-gynecologist with a focus on cervical pre-cancer and cancer, racial disparities in cervical cancer screening, reproductive health, and the use of digital technology to address unmet needs in women’s health. As the global medical affairs lead supporting oncology assays at Roche Diagnostics, she is a contributor to the global movement to eliminate cervical cancer while working to move the needle on physician education and health literacy in historically excluded communities. Dr. Kay earned her medical degree at the SUNY Upstate Medical University and completed residency training at Hofstra-Northwell Health in New York.
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