Jeff Andrews, MD, ob-gyn and vice president of Medical Affairs at BD, sits with Contemporary OB/GYN® to discuss the findings from a survey by the Harris Poll regarding HPV and cervical cancer screening.
JA: This survey was commissioned to the to the Harris Poll that was conducted during the middle of November, involving 872 US women ages between 18 and 64.
LC: What were some of the major findings?
JA: I think one of the major findings was the gap in knowledge that many women have about HPV as the cause of cervical cancer and other cancers about how to be screened how frequently to be screened. There wasn't as much knowledge level as we thought, then there was also some challenge in terms of access. For women having access to screening tests, and there was some variability there in terms of race and ethnicity, that's important.
The third notable finding was that 79% of the respondents said they would likely use self collection. And that surprised me because it's not available currently. So it indicates a very high interest in something that could come in the future.
LC: Were any of those results particularly surprising, apart from the major knowledge gap?
JA: Well, I thought that the major problem was access, not knowledge. And so it's very important to understand that because there are opportunities for many different groups to provide more information, better information, information in a variety of formats, to make sure that women do understand the cause and how to prevent cervical cancer.
LC: The findings noted that over 10%, of Black and Latina women have never received a Pap test, you know, versus just 5% of white women. Why do you think those numbers are so drastically different.
JA: Yeah. It's, it's has hopefully it has to do with demographics in terms of economics, healthcare, insurance, and where people live in terms of rural versus urban. You know, there's, it's possible that there's more to it than that. But it seems to be that it's more difficult for women in many different categories, if you will, to access health care, to get time off work to find modes of transportation.
And then you may have noticed in the survey that, for instance, Hispanic women were, were more likely to procrastinate because of embarrassment at 22%, compared to Black women reported at 4% and 9%, for non-Hispanic white women. So some of the reasons why very, but there's definitely disparity between white and nonwhite women.
LC: What can providers do on an individual level, one, to encourage patients to get tested to educate them, and to destigmatize getting tested?
JA: So one of the problems is inherent in the question, which is, are is the provider the right person, because, as we know, from our own experience, visits to a doctor are kind of compressed. And if if the intention for the visit is to come in with a problem, the doctor may use all of the available time to focus on the problem and not use it for preventive measures, whereas it's more reliant on a patient in the United States to schedule an appointment specifically for preventive and wellness care where this screening would take place.
However, in the United States, the majority of screening that does happen is what we call opportunistic, meaning the person's in the office for some other reason. And the provider does say, Hey, I see you're due for cervical cancer screening or breast cancer screening. Let's take care of that while you're here. So that's that's very helpful. I think the government at a federal state and local level has a role in providing information but also making sure that women know where they can access the service.
LC: You mentioned at-home testing and regarding access and even embarrassment, what might at home testing being accessible do to improve the rates that the survey found?
JA: Many women receive their primary health care from an internist or a family medicine doctor, and then they may also have an obstetrician gynecologist or not and some primary care doctors do cervical cancer screening as it is done now, which involves a pelvic exam with a speculum and a cervical collection by the provider, but some of them do not.
So being able to self sample would give all women an opportunity to get the test done themselves, because it can be done at home. It avoids those issues of getting time off work, transportation, childcare, all those types of things. And it avoids any of the embarrassment issues as well. When self sampling is introduced, that will require a clinicians order, because it's important that there be someone available to the woman to discuss the results, whether they're negative or positive.
So it will be possible to get that order from someone's regular doctor or to contact someone specifically for the cervical cancer screening test, which is the HPV test that a doctor would order by telemedicine and then the person would receive it through the test, send it to the lab, and then get a call with with the result.
So at the moment, 30% of women in the United States are not screened within the appropriate interim interval for cervical cancer. And those 30% of women experience 60% of cervical cancer that occurs in the United States.
So if we can reach more of these, these women that aren't currently being screened, with self sampling that will help the individual women as well as those statistics that I just mentioned.
BD was the first company to have self sampling with our HPV test, Onclarity, approved in Europe. And we also have approvals in other countries, including Australia. In the United States, the regulation of these tests is through the FDA.
So we've been working with the FDA and others to to promote the idea that self sampling would be an advantage for women in the United States. And also the American Cancer Society has been advocating this and recently, when the White House reignited the Cancer Moonshot. They collaborated with the American Cancer Society to sponsor a roundtable for cervical cancer prevention, which will be focused on education for women. tackling those disparities that we talked about, and promoting primary HPV or HPV is the first test as well as self sampling of HPV.
LC: Is there anything else you think folks should know about? You know, the survey or cervical cancer screening HPV screening in general?
JA: Just HPV stands for Human Papilloma Virus. There's several genotypes that are considered high risk, and it can cause six different cancers including cervical cancer, but most people who acquire an infection with HPV are able to clear the infection with their own body's immune system.
But if that infection persists, which means on repeated testing, you're still able to get a positive hp V result, then that persistence of the virus is what can lead to precancerous changes. It takes a few years, which is good because it means if you're screened periodically, we will be able to find pre cancer and treat it and prevent cancer. That's that's how the system works.
So it's important to learn about HPV but there's also a vaccine for HPV which is typically given to girls and boys in the age group of nine to 13. And so that's primary prevention, which decades from now will mean the cervical cancer rate will be very, very low. But in the interim for all the people who haven't been vaccinated, we need to continue with screening. And the HPV test is the best screening test to use. It's replacing what's known as the Pap test.