Getting screened for strains of the cervical cancer-causing human papillomavirus (HPV) can be difficult for many women, but not getting tested can have deadly consequences. In 2019, an estimated 4,250 women will die from invasive cervical cancer — a number that, the American Cancer Society notes, has not changed much in 15 years. To bring that number down, some companies are trying to bring HPV tests out of the doctors’ offices and into women’s homes.
“Half of the cervical cancers that continue to occur in the US are amongst women who rarely screen or have never been screened,” says Vikrant Sahasrabuddhe, program director in the Division of Cancer Prevention at the National Cancer Institute. Notably, a Centers for Disease Control and Prevention (CDC) report from 2017 found that rural areas have higher rates of cervical cancer than their urban peers, despite a lower incidence of cancer overall.
For Jessica Horwitz, the clinical development director for telemedicine company Nurx, there’s a simple solution to this persistent problem: enable women to test themselves at home. After finding success using the telemedicine model to increase access to both birth control and drugs that reduce the risk of HIV infection (also known as Truvada or PrEP), Nurx recently launched a new at-home HPV testing service that should be relatively easy for patients to use.
“It’s a vaginal swab,” Horwitz explains over the phone, noting that after the user swabs their vagina, they are directed to break the tip off the swab off, insert it into a container that’s provided with the testing kit, and mail it back to Nurx for analysis.
At-home sexually transmitted infection (STI) screenings have been a part of the reproductive health landscape for years: in 2012, the Federal Drug Administration approved an at-home version of the OraQuick oral swab HIV test, enabling consumers to quickly determine their HIV status in the privacy of their own home. Similar at-home tests are marketed for other STIs, including chlamydia, gonorrhea, and trichomoniasis. Although not all at-home tests provide the instant results generated by OraQuick (many at-home tests, including the HPV test distributed by Nurx, require the user to send the kit to a lab for testing), they all come with the guarantee of discretion and flexibility, which Nurx hopes will attract clients who might have otherwise passed on a cervical cancer screening.
Nurx is just one of many companies entering the HPV-testing space. Let’s Get Checked, Everly Well, Private iDNA, and Self Collect are some of Nurx’s competitors in the home testing market. In countries like Canada, Australia, and the Netherlands, self-tests have been available for several years.
These at-home screenings are not without potential risks, however. User error can lead to false negatives. “Somebody who gets a result that’s negative from a doctor’s office, it’s guaranteed,” says Sahasrabuddhe, but with an at-home test, there’s more uncertainty. A false negative could result in someone confidently skipping out on screening for several years only to discover they have cervical cancer once it’s too late to effectively treat. But Sahasrabuddhe is quick to note that there’s not enough data to assess whether false negatives are a major problem.
Additionally, at-home screenings are not a panacea unto themselves. If someone tests positive for one of the cancer-causing strains of HPV, the test will not prevent them from developing cancer. For that, patients will need to undergo follow-up tests and, potentially, a colposcopy, biopsy, and removal of any abnormal cells found on the cervix. But Horwitz hopes that it will serve as an entry point to care — one that Nurx is happy to facilitate. “We have a very robust RN team that has a large referral network,” Horwitz explains. “If someone tests positive for HPV, they’re going to do everything within possible range to find someone in their community that they can refer them to for in-person care.”
And when a referral isn’t possible — perhaps because the person lives somewhere remote and far from Nurx’s referral network — “the worst outcome is you’ve given someone power and information,” Horwitz says.
For health professionals, at-home HPV screenings, along with other home STI tests, offer an opportunity to extend reproductive health care to populations that aren’t currently getting access to it. Hopefully, that will help to further reduce rates of cervical cancer and other illnesses in the process. “From a public health point of view, we do recognize the importance of bringing in women who would otherwise be missed,” Sahasrabuddhe says, a point Horwitz emphatically agrees on.
“If traditional brick-and-mortar medicine was meeting the needs of every single woman in America, then home HPV screening wouldn’t need to be a thing,” Horwitz says. “But it’s not.”