Minipad-based HPV testing shows promise for cervical cancer screening

A large community-based study published in The BMJ found that testing menstrual blood collected on a sanitary minipad could offer a reliable, non-invasive alternative to clinician-collected cervical samples for human papillomavirus (HPV) screening, which demonstrated comparable accuracy for detecting high-grade cervical lesions.

Cervical cancer remains a leading cause of cancer-related death worldwide despite being largely preventable through screening and early treatment. Persistent infection with high-risk HPV drives cervical carcinogenesis, and HPV testing has become the cornerstone and “principal approach” of screening programs. However, clinician-based sampling faces barriers in many settings, including limited medical infrastructure, cultural concerns, and discomfort associated with pelvic examinations, which can reduce participation and undermine population-level effectiveness, according to the study authors. As a result, the investigators sought to compare the diagnostic accuracy of minipad-collected menstrual blood versus clinician-collected cervical samples to test for HPV.

Why menstrual blood testing matters

Self-sampling approaches such as vaginal swabs and cervicovaginal brushes have helped expand screening access, but they are not universally acceptable and can present technical challenges. Menstrual blood collection using sanitary pads offers a distinct alternative that aligns with routine menstrual practices and avoids vaginal manipulation. Prior small studies suggested strong patient preference and encouraging concordance with clinician sampling, but evidence from large, real-world community populations had been lacking.

To address this gap, researchers conducted a large cross-sectional population-based study evaluating whether minipad-collected menstrual blood could match clinician-collected cervical samples for HPV testing in detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and grade 3 or worse (CIN3+).

The study enrolled 3068 women aged 20 to 54 years with regular menstrual cycles from 4 urban and 3 rural communities in Hubei Province, China, between September 2021 and January 2025. Participants underwent HPV testing using both minipad-collected menstrual blood and clinician-collected cervical samples, along with ThinPrep cytology. Women who tested positive by either HPV method or had abnormal cytology were referred for colposcopy-directed biopsy to allow for direct comparison of diagnostic accuracy for clinically meaningful cervical lesions.

Minipad vs clinican HPV testing sensitivity

For detection of CIN2+, minipad-based HPV testing demonstrated a sensitivity of 94.7% (95% CI, 80.9% to 99.1%), comparable to the 92.1% sensitivity observed with clinician-based HPV testing (95% CI, 77.5% to 97.9%; P = 1.00). Specificity was slightly lower with minipad testing at 89.1% (95% CI, 88.0% to 90.2%) compared with 90.0% (95% CI, 88.9% to 91.1%) for clinician sampling (P = 0.001).

Despite this difference, the negative predictive value was identical for both approaches at 99.9% (95% CI, 99.7% to 100.0%; P = 1.00), indicating that a negative result reliably ruled out high-grade disease. Positive predictive values were also similar, resulting in 9.9% for minipad testing versus 10.4% for clinician testing (P = 0.82). So was screening efficiency, measured by referrals per CIN2+ detected (10.1 vs 9.6; P = 0.82).

Can minipad HPV testing be integrated?

The findings suggest that minipad-collected menstrual blood testing can achieve diagnostic performance comparable to clinician sampling while potentially overcoming key barriers to participation. By integrating screening with routine menstrual hygiene practices, this approach may be particularly valuable in low-resource or culturally sensitive settings where uptake of pelvic examinations remains low.

The authors noted that broader adoption could support efforts to expand cervical cancer screening coverage without compromising accuracy, though implementation considerations such as standardization of collection devices and integration into existing screening pathways will be critical.

Additionally, the investigators noted unanswered questions and that future research is needed for direct comparative studies to evaluate “HPV testing of menstrual blood against established self-sampling methods (eg, vaginal swabs, cervicovaginal brushes), assessing not only diagnostic accuracy but also accessibility, particularly in under-served populations,” they wrote.

“Secondly, large scale implementation research must quantify gains from real world screening coverage, with longitudinal studies tracking recruitment, retention, and linkage-to-care rates. Real world trials should measure cost effectiveness and operational barriers in national programmes (supplementary appendix supplementary note 4).76 Thirdly, future work should validate triage biomarkers for HPV testing of menstrual blood to optimise specificity and sensitivity, reducing unnecessary referrals to colposcopy.”

Reference:

Tian X, Cao C, Wang L, et al. Testing menstrual blood for human papillomavirus during cervical cancer screening in China: cross sectional population based study. BMJ. Published February 4, 2026. Accessed February 5, 2026. https://www.bmj.com/content/392/bmj-2025-084831