For many women, Pap smears are an uncomfortable, even painful experience. While effective at screening for cervical cancer, the technique calls for the patient’s legs to be held apart and a metal speculum to be inserted into the vagina to scrape cells from the cervix. The process can cause physical distress and evoke mental trauma.
Pap smears, however, might soon become a thing of the past. In May, the Food and Drug Administration approved a new method of testing for cervical cancer that will allow women to self-swab their own vaginas while in a medical setting and leave a sample for testing, much like how urine samples are taken. The new self-collection method is made possible by a breakthrough in technology that lets samples be taken from the vagina, not the cervix, and still be adequate for testing. In taking this step, the U.S. has joined many other countries, such as Denmark and Australia, in making cervical cancer screening more convenient and comfortable.
“Anything that can help increase cervical cancer screening will be helpful in lowering cervical cancer rates,” Dr. Lucy Chie of Beth Israel Deaconess Medical Center, told the Sampan.
While still under review, there is also the possibility that at-home testing—with women self-swabbing at home and sending their samples to labs for testing—will be implemented next year.
“Self-collection may increase screening uptake,” said Dr. Jenny Ruan, an obstetrician and gynecologist at Tufts Medical Center. “At Tufts Medical Center, we are working with our colleagues in the laboratory to better understand the sensitivity and specificity of the test. After we have completed the evaluation, we can then disseminate information to patients regarding this novel process in cervical cancer screening.”
There is hope that these new advances might close the screening gap associated with the Pap smear, which has historically failed to reach wide swaths of people. In fact, according to the New York Times, thousands of women die from cervical cancer per year—deaths that are completely preventable. Statistics indicate that women living in rural areas, with lower socioeconomic statuses, and without insurance are much more likely to be under-screened. African American women are 30% more likely to develop cervical cancer and 60% more likely to die from it than non-Hispanic white women. African African women make up 14.4% of the female population and around half of the African American population, yet they have the highest mortality rate for heart disease, stroke, diabetes, and cancer, including cervical cancer. Asian American women have one of the lowest screening rates. Some view the current state of cervical cancer screening that’s reliant on the Pap smear is deeply flawed.
“These disparities can be due to a variety of reasons,” Dr. Ruan said of the health outcomes of African Americans. “This patient population may have lower Pap smear screening and follow up rates due to social disparities such as access to healthcare and health literacy… [or] lower rates of HPV vaccination, which can help protect against certain types of HPV that can cause cervical cancer.”
For example, African American women with cervical cancer are likely to be diagnosed at a later stage, which decreases the odds for survival. One reason for this is due to distrust of the medical community, and with good reason; from the inhumane practices of J. Marion Sims, widely considered the father of modern gynecology, to the Tuskegee syphilis study of the 20th century, there is a precedent for the exploitation of African Americans in the name of medical study. In addition, a lack of follow-up care and the provision of relevant information to patients are also serious issues in ensuring that African American women are diagnosed and treated in a timely manner.
In response, the American Cancer Society recently launched the new study VOICES of Black Women, which aims to enroll and follow more than 100,000 African American women for the next 30 years. The study’s investigators hope that their findings will shed more light on the disparities and barriers African American women face in treating their cancer. Another group, Tamika and Friends, was founded by former cervical cancer patient Tamika Felder. Felder used her own experience in navigating the process and advocating for herself to start a support group for other women in similar circumstances. Now called Cervivor, Inc., the group helps to link women with cervical cancer into a global support community.
Others are turning to technology for a new solution. Outcomeus, founded by Brian Meshkin, is working on developing a new medical model that emphasizes predictive and preventive healthcare. The new model plans to integrate artificial intelligence to better tailor healthcare to individual needs and expand its access. In particular, Meshkin has highlighted the importance of predictive healthcare in not only addressing manifested symptoms but also “social determinants” and “systemic barriers” to care—in other words, looking not just at the individual but at the whole.
Asian American women are another vulnerable population when it comes to cervical cancer screening. Studies show that as a whole, Asian American women are generally poorly educated about cervical cancer, with little awareness of prevention practices such as regular screening. Asian American women are often lumped together into one large category and historically underrepresented in medical research. Only a small percentage of clinical trials in the U.S. focus on minority populations, and only five such trials focus on Asian Americans, compared to 83 for African Americans and 32 for Hispanics . This means that cultural, behavioral, and socioeconomic differences among Asian communities are easily overlooked.
However, more knowledge about these factors are needed to better understand the different screening behaviors among Asian American women. For example, according to the 2011 study ”Overcoming Barriers to Cervical Cancer Screening Among Asian American Women,” Asian American women are far less likely to undergo Pap smears when compared with the general U.S. population. But even more specifically, Vietnamese, Korean, and Chinese women have higher rates of cervical cancer, compared to other Asian populations such as Japanese or Filipino women. Studies conducted show that 33% of Vietnamese American women in the eastern U.S. have never had a Pap smear; 40% of Korean American women in California; and 28% of Chinese American women in the eastern U.S. These statistics are partly due to technical barriers to screening, such as lack of health insurance or language difficulties. However, psychosocial and cultural factors undoubtedly also play a great part.
Researchers say the new self-collection testing method marks an important step of improvement, but it remains to be seen if a true difference will be made in how the medical community addresses female reproductive health.
“For those who fear pelvic exams, that fear should not prevent them from coming in for gynecology care. Pelvic exams may be recommended to help with screening and evaluation, but it will never be required without a patient’s consent,” said Dr. Chie. She added, “Our practice will continue to educate our patients and communities on the importance of making time for preventative health care and wellness visits, which includes cervical cancer screening. However, screening alone does not prevent or cure cervical cancer or precancerous conditions. We need to ensure patients have access to trusted medical care to discuss and understand their results.”
