UNC Lineberger Comprehensive Cancer Center is the first cancer center to enroll participants in a national study focused on expanding access to cervical cancer screening through HPV self-testing. This approach could help reduce the number of women diagnosed with cervical cancer due to underscreening.
The National Cancer Institute launched the “Last Mile” initiative as part of the Self-collection for HPV testing to Improve Cervical Cancer Prevention (SHIP) trial network in January.
UNC Lineberger’s Lisa Rahangdale, MD, MPH, professor of general obstetrics, gynecology, and midwifery at UNC School of Medicine, is the study’s lead investigator at UNC. “Around half of people who are diagnosed with cervical cancer are those who are underscreened,” Rahangdale said. “The reasons for not screening are complex, but some barriers may be overcome with HPV self-testing.”
Cervical cancer is highly preventable due to effective screening tests and the HPV vaccine, and it is often curable when detected early. According to the American Cancer Society, half of those diagnosed with cervical cancer have never been screened, and Black women and Native American women are 65% more likely to die from cervical cancer than white women.
In the study’s current phase, Rahangdale and colleagues are focused on enrolling participants who are undergoing a colposcopy exam of the cervix after receiving an abnormal Pap smear result or a positive HPV test. According to the National Cancer Institute, nearly all cervical cancer is caused by HPV infection.
The goal is to assess whether home-based HPV self-testing is a feasible and effective. The study’s second phase will target individuals from underscreened populations, a group particularly vulnerable to late-stage cervical cancer diagnoses.
The U.S. Preventive Services Task Force recommends that women aged 21 to 29 undergo a Pap smear every three years. Women aged 30 to 65 years should undergo a Pap smear alone every three years or HPV testing, with or without a Pap smear, every five years.
UNC Lineberger’s Jennifer Smith, PhD, MPH, professor of epidemiology at UNC Gillings School of Global Public Health, is a co-principal investigator on the study and will take it from the clinic into the community. Her extensive research on HPV self-testing in hard-to-reach populations will help ensure the study reaches the most at-risk groups.
According to the UNC Lineberger Cancer Health Assets and Needs Assessment initiative, which compiled and analyzed data from 2015-2019, women living in rural North Carolina are 30% more likely to be diagnosed with cervical cancer and have a nearly 28% higher risk of death than those who live in urban settings.
“This study holds significant potential to impact our patient population,” Rahangdale said. “There are parts of North Carolina that have higher-than-average cervical cancer rates. If screening were more accessible—through self-testing at home, pharmacy-based testing, or in-office testing without a pelvic exam—we could identify more at-risk individuals earlier and prevent cancer.”