Beverly Green, MD, MPH, explains the rollout of a mailed HPV self-collection program

A mailed and clinic-based human papillomavirus (HPV) self-collection program increased cervical cancer screening rates while reducing reliance on pelvic examinations in a large U.S. health system, according to findings published in The New England Journal of Medicine Catalyst and discussed by Beverly B. Green, MD, MPH, Senior Investigator, Kaiser Permanente Washington Health Research Institute; Family Physician, Washington Permanente Medical Group; Professor, Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine; Clinical Professor, Department of Family Medicine, University of Washington School of Medicine.^1,2

The program, implemented at Kaiser Permanente Washington, built on prior randomized trial data demonstrating that mailed HPV self-testing kits can improve screening uptake and reduce costs.

“My team led a randomized trial that was also performed at Kaiser Permanente Washington that showed that offering individuals who were due for cervical cancer screening mailed HPV self-testing kits increased cervical cancer screening, and led to cost savings per each additional exam. After the study was over, Kaiser Permanente Washington decided to adopt the program,” Green said.

In the real-world rollout, the health system expanded the approach to include both mailed kits and in-clinic self-collection for patients aged 30 to 64 years who were due or overdue for screening. “In addition to mailing kits to patients who were at average risk for cervical cancer and age 30 to 64, they wanted to also implement self-testing at the point of care in the clinic, either at the time of a well exam or at the time of any visit if they were due or overdue for screening, which was different than the study,” she explained.

A 6-month evaluation comparing pre- and post-implementation periods found a 2.2% increase in screening across approximately 40,000 eligible individuals. However, this improvement was smaller than gains seen in earlier trials, prompting further investigation.

Implementation challenges played a key role. Not all eligible patients received kits during rollout, limiting program reach. “When they rolled it out, that was not the case. So they wanted to make sure the lab was not overwhelmed with too many results and too many positive results for colposcopies, and so they initially just rolled it out to individuals [who] were coming due, and they put a hold on those that were overdue, who definitely needed to be screened,” she said.

“About 12.5% were actually mailed kits, and about 25% of people returned them, so actually people were very responsive,” Green said. The program also shifted screening practices, with approximately one-third of screenings completed via self-collection and a corresponding reduction in pelvic examinations.

“What we found was it was highly acceptable to the clinicians,” she said, noting that self-collection allowed providers to address other patient concerns and reduced barriers associated with pelvic exams. However, knowledge gaps persisted.

“Clinicians weren't always aware of how accurate it was, and it is actually, in studies and meta-analyses, as accurate as HPV collected by a physician, and they're both an excellent test and more sensitive than the pap smear,” Green said.

The program also maintained strong follow-up systems for patients with positive test results. Completion rates for diagnostic colposcopy among individuals with high-risk HPV-16 or HPV-18 were comparable to those observed in prior trials and significantly higher than preprogram levels.

For more specific study data and results, click here to view our previous coverage.

References:

1. Fitch J. NEJM: How does an HPV self-collection program impact screenings? Contemporary OB/GYN. Published May 20, 2026. Accessed May 21, 2026. https://www.contemporaryobgyn.net/view/nejm-hpv-self-collection-program-impact-screenings-
2. Green BB, Mogk J, Crawford-Gallagher B, et al. Impact of a clinic- and mail-based cervical cancer human papillomavirus self-collect screening program. NEJM Catalyst. 2026;7(6). doi:10.1056/CAT.25.0420