Self-sampling can replace the Pap smear: the new speculum-free cervical cancer test

A self-sampling kit for testing for cervical cancer. (Elizabeth Renstrom/The New York Times)

For some women, getting a cervicovaginal cytology, or proof of Pap smear, It’s a nightmare. Since she was in her twenties, Kevinn Poree has suffered chronic vaginal paina pain that made her scream and writhe in pain the first time a gynecologist tried to insert a speculum.

“I completely lost control,” said Poree, 38. After the speculum was removed, she began “crying in the fetal position.” Since then, like many women, she has waited in terror for the test. cervical cancer screeningwhich involves separating the patient’s legs with stirrups and inserting a cold metal device into the vagina so that the doctor can lightly scrape the vagina to obtain a sample of cells from the cervix.

Even if you don’t have a problem with severe pain, research shows that many women experience a Pap smear. discomfort due to a whole complex series of physical and emotional reasons.

“There are people who are very concerned distress” by fear or shame, or by a history of trauma sexualhe explained Karen Knudsenexecutive director of the organization American Cancer Society.‌ Now, a few healthcare companies are preparing to introduce A new model for cervical cancer screening and prevention that does not require the use of a speculum: the autosamplingwhich consists of the woman takes the sample from your vagina in the doctor’s office using only a narrow swab very similar in appearance to the one used for a COVID test.

After collecting the sample, a laboratory analyzes it for the following: strains of human papillomavirusor HPV, which is more likely to cause cervical cancer.‌ A key change in HPV testing made this technique possible: labs can now test samples taken from the vaginal walls rather than the cervix itself.‌ With the addition of self-sampling, USA will follow the example of countries such as Australia, Denmark, the Netherlands and Sweden, who have gradually introduced self-sampling for cervical cancer testing for some years now with great success in its adoption.

Two decades of research suggest that this method is equally effective that traditional Pap tests to prevent cervical cancer in women 25 years and older.‌ In May, the U.S. Food and Drug Administration (FDA) authorized the use from the self-sampling tools of pharmaceutical companies Roche and BD (Becton, Dickinson and Co.) in healthcare facilities.

Patients can get tested in private and leave the sample with a health care provider, similar to when they give a urine sample. But company representatives said the longer-term goal is to have home cervical cancer tests, so that the health care provider orders a test, the woman Take the sample at home and then send it to a lab for an HPV test.

If the test result is positive, your doctor will tell you what steps to take next. While home testing is already available in other countries, this method is still in its infancy. FDA review process in the United States. It could be approved as early as next year. For women who want to collect their own sample before then, BD kits will likely begin shipping to medical facilities in September, and Roche’s will be distributed later this fall, according to spokespeople. Both tests require a needle to be inserted into the vagina. swab about 8 centimeters long.‌

Experts hope the tests, which will be covered by public and private insurance and will be free at many federally funded clinics for uninsured women, will help reach the 30 percent of eligible women in the United States who do not get regular screenings, including those who avoid Pap tests because of the discomfort they cause.

This lack of testing causes thousands of deaths each year. deaths from cervical cancer that could be avoided. Self-sampling is possible now that women are throwing away the deep-rooted belief in the culture that they must endure gynecological and reproductive pain. In addition to having made advances in pain relief from IUDs and the side effects of menopause, women’s health companies are now designing more comfortable speculums for gynecological exams.

Erin Kobetz, Associate Director of Outreach and Community Engagement at the Center Sylvester Comprehensive Cancer Center in Florida, which has spent two decades studying self-sampling for cervical cancer, said that “we have been waiting a long time” for these tests. Why the Pap test has endured ‌Although many women dislike it, the experience of patients with the Pap test is Pap smear with stirrups and speculum has remained almost unchanged since the 1940s, when it (named after its inventor, Dr. George Papanicolaou) became standard practice in the United States.

In part, that’s because it works, said Knudsen of the American Cancer Society. The advent of the Pap test reduced cervical cancer mortality by more than 70 percent in the 20th century, so in that sense, “the Pap test is certainly a success,” she said.

In a cervical cytology, the doctor takes a sample of cells from the cervix, transfers it to a slide, and sends it to a cytologist, who looks for precancerous or cancerous cells. If the test is positive for the presence of abnormal cells and the disease is still in its early stages, the doctor can usually remove the affected area and prevent the disease from progressing. At this time, in many cases, the samples taken for the Pap test are also analyzed for detect HPV strains that are more likely to cause cervical cancer. If an HPV test is positive for one of these strains, doctors closely monitor the patient for precancerous cells over the next few years (if abnormal cervical cells are also detected, the patient may receive some type of treatment).

Cervicovaginal cytology and HPV testing are especially effective in prevention cervical cancer because the disease is slow progress Compared to many other types of cancer, it usually takes several years to overcome the precancerous stage.‌ There are still deaths from cervical cancer that could be prevented. ‌Despite the effectiveness of cervical cytology, the downward trend in the number of deaths from cervical cancer has leveled off since 2008.

In the United States, about 11.500 in prisonare diagnosed with cervical cancer every year and 4000 die for that reason.‌ Public health officials say many of those deaths could be prevented, in part because the current testing protocol doesn’t reach millions. “The incidence has actually been going down markedly” because of the Pap test, Kobetz said, but the decline “hasn’t been equitable.”‌

Typically, not many women who live in rural areas Without easy access to doctors, tests are done, and the same is true for women in lowest socioeconomic level, Black and Latina women. Insured women were four times more likely to have had a test in the past year than uninsured women.

Some experts told him The New York Times who hope, albeit with some reservations, that more testing through self-sampling, together with more decisive vaccination, will help World Health Organization to achieve its goal of eradicating cervical cancer soon. “It’s the cancer we could make disappear in our lifetime,” said Kobetz. She explained that, from the beginning of her professional life, “I thought I would work so that one day I would be out of a job.”