Rethinking the Pap Smear

The pap smear has saved countless lives, but millions of women also dread it. Now there's an alternative that's easier, more private, and just as accurate. 

Globally, cervical cancer is the fourth most common cancer among women. In the US, we've made enormous progress in detecting it through regular screening using the PAP smear to look for abnormal cells. Of the 4,000 or so annual cases here, most occur among the poor and those without access to care. 

Cervical cancer is one of the few human cancers caused by an infection — specifically, a virus called human papillomavirus, or HPV. Because almost all cases of cervical cancer result from HPV infection, this introduces a new screening option. Instead of using a PAP smear, which requires a woman to undress and a clinician to insert a speculum and scrape cells, clinicians can instead check for signs of HPV infection. 

In Los Angeles, the Venice Family Clinic works with a particularly high-risk group: unhoused women. Studies report that unhoused women have rates of HPV infection twice as high as the general female population. 

Carrie Kowalski is a clinician at the Venice Family Clinic who specializes in caring for unhoused women. She says her patients find it particularly challenging to get a PAP smear: 

"This is an uncomfortable and invasive test. It often requires an appointment, and having to wait to come to the clinic, and then, once you're there, having to have a pelvic exam involving a speculum. And this for some women, not ideal. It's less ideal for my patients who are experiencing homelessness, who might have higher rates of sexual abuse and sexual trauma." 

So, the Venice Family Clinic has been evaluating a new self-collection test recently approved by the FDA. Instead of scraping cells off the cervix, this test looks for the genetic fingerprint of the HPV virus itself. 

“What this is, is a test that a woman can do on her own, still in a clinical setting, but the woman is given a swab with instructions, sent to the bathroom. Just inserts the swab into the vagina for 10 to 30 seconds and then returns the swab to us to send out as part of a kit." 

The new test allows for privacy and increased comfort. And it's accurate. 

“It's a very powerful way of testing that ends up being a lot easier for a lot of our women experiencing homelessness." 

When the Venice Family Clinic asked women about the self-collection experience, responses were overwhelmingly positive. It was more comfortable, didn't require a separate appointment, and wasn't embarrassing. 

The test isn't perfect — it misses a small number of cases — but so do Pap smears. If either test comes back positive, the woman may need a traditional pelvic exam for further evaluation. Even more important than being inexpensive and easy to administer, the self-collected HPV test can be lifesaving.

– Dr. Michael Wilkes with a Second Opinion

Further Reading:

• Pap smears or self-swabs?
• What You Need to Know About HPV Testing with Self-Collected Samples
• Self-Testing: Another Tool to Fight Cervical Cancer