The standard method to screen for cervical cancer is called a pap smear. Women go to a medical facility, and a clinician takes a sample of cells from the cervix. The cells are then examined under a microscope for signs of cancer.
But epidemiologist and physician Gina Ogilvie, of the Centre for Disease Control in Vancouver, says not all women get pap smears when they should. "Even in a country like Canada which has universal health care," she says, "we found that certain groups of women, particularly lower socio-economic status women, often are less likely to have had pap smears."
Cervical cancer starts when a woman contracts the sexually-transmitted human papilloma virus, or HPV. Only about ten percent of women with HPV will develop cancer. But for women who are less likely to get routine pap smears, Ogilvie says testing for HPV can help identify those who may be at risk for cancer.
And test samples for HPV are much easier to collect than for a pap smear, because the specimen can be collected from anywhere in the vagina. "You don't necessarily have to […] get the specimen from this one part of the cervix," Hillier explains.
By following a simple diagram with instructions, women can collect the specimen themselves for analysis, without having to go to a clinic.
To determine how readily this method would be accepted, Ogilvie sent trained outreach nurses to women's centers and homeless shelters in a low-income neighborhood of Vancouver. Out of the 300 women that the nurses approached, 152 agreed to participate. Forty-three of their test samples came back positive for HPV.
The nurses were able to re-contact 35 of the women for follow-up screenings. Ogilvie says that it was the nurses themselves who were critical to the study's success. As she puts it, "We used an […] established team who had trust and respect in the community. And they know the community as well, so they know these women."
For others who may be interested in implementing this collection method with another, similar population of women, Ogilvie says it is essential to use outreach workers who are known and trusted by the community.
She stresses that all women should still get regular pap smears, because they are a more accurate predictor of cervical cancer than tests for HPV. But, she adds, for women who are not getting tested, self-collection can provide a way to increase access to this life-saving screening. Her research is published in the August 28th, issue of the Canadian Medical Association Journal.