Advancing Cervical Cancer Screening Through Emergency Department-based Self-Sampling
Description: Cervical cancer (CC) is among the most preventable forms of cancer and screening is recommended for all 21- to 65-year-old people with a cervix. On January 23, 2017, the New York Times reported that cervical cancer mortality rates in the US are higher than had previously been thought and that the mortality rate for black women more than twice that of white women. According to the CDC’s 2021 data, only 74% of US women were up-to-date with screening. This persistent failure to extend CC screening to all eligible people has been characterized as the “Last Mile” problem.
In 2018, the USPSTF recommended testing for high-risk human papillomaviruses (hrHPV) as an effective CC screening method for people age 30-65. hrHPV testing presents the possibility of self-sampling for test specimens - providing convenience, privacy, and comfort. Self-sampling has been demonstrated to have a high level of acceptability, to be accurate and valid relative to clinician-collected specimens, and to increase participation in CC screening. Self-sampling is recommended by the World Health Organization and has been integrated into the screening guidelines of several countries including Australia and the Netherlands. In the wake of the 2022 President’s Cancer Panel advising “the FDA [to] prioritize review of the evidence supporting HPV self-sampling to ensure that it is available to women in the US as soon as possible”, self-sampling received FDA approval in May, 2024 for on-site use at healthcare facilities. Now that the FDA regulatory hurdle has been overcome, the next step is to leverage self-sampling to increase CC screening participation among the people who need it most. Disparities in CC screening are pronounced among a variety of populations, including racial and ethnic minorities, patients with lower education levels, gender minorities, the under-insured, and rural individuals. The group most likely to be under-screened is people who use the emergency department (ED) as their usual source of care. The ED setting, therefore, is optimal for the deployment of HPV self-sampling. Our research team is at the forefront of developing ED-based interventions to promote CC screening.
The proposed pilot trial will examine the preliminary utility, operational feasibility, and patient acceptability of an ED-based hrHPV self-sampling intervention. ED patients identified as not-up-to-date with CC screening recommendations will be recruited into our study. Participants will be offered an hrHPV self-sampling kit, instructed in its use, and provided the opportunity to complete the test in a private restroom in the ED. At 150 days post-visit, we will follow-up with patients to determine use of the hrHPV self-sampling kit and completion of subsequent clinic-based CC screening. The observed rate of CC screening will then be compared to the rate observed among participants in a separate study who only received in-ED recommendation for screening. This first-in-field study “meets people where they are” to improve health equity by bringing cervical cancer screening directly to them.
Funder: American Cancer Society
Amount: $297,000
Funding type: award
Start date: 2025-11-01
End date: 2027-10-31
Investigator: Beau Abar
Institution: University of Rochester Medical Center (URMC), Rochester, NY
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Funded outputs count: 0
Funder award ID: DBG-25-1374559-01-ESED
OpenAlex ID: G425380086