A conversation with Abbey Berenson, M.D., MMS, Ph.D., obstetrics and gynecology professor at the University of Texas Medical Branch

New guidelines from the Health Resources and Services Administration (HRSA) now allow women ages 30 to 65 at an average risk of cervical cancer to choose a self-swab option to screen for human papillomavirus (HPV), one of the leading causes of cervical cancer, instead of a Pap smear.

Additionally, most private insurance plans will have to cover both HPV screening and follow-up testing without cost-sharing by January 2027.

The self-swab option involves a tampon-like device that is inserted into the vagina by the patient. The patient then twists the handle to collect cells for examination. This is less invasive than a Pap smear, in which a clinician uses a metal or plastic device called a speculum to widen the vaginal canal so that they can collect cells directly from the cervix.

Abbey Berenson, M.D., MMS, Ph.D., director for the Center of Interdisciplinary Research in Women's Health at the University of Texas Medical Branch, has been involved in HPV vaccination efforts that have administered more than 9,000 doses since 2016.

Berenson recently sat down with Managed Healthcare Executive to discuss the implications of the new HRSA guidelines.

From a public health standpoint, how significant is it that private insurers will cover this new screening option?

It's a wonderful addition, because there are many patients that are afraid of a speculum exam, and so they avoid going in for a Pap smear. This self-test will give them an ability to do it in privacy, to do it themselves. It should increase the number of women screened and increase the number of early cancers detected.

Based on your work in East Texas, which communities stand to benefit the most from the expanded screening options?

In East Texas, when you get toward the Louisiana border, there's an increased rate of cervical cancer, so those counties will benefit if the people participate in the HPV swab testing.

Part of the reason is the anti-vaccination beliefs that many people have in that area. They did not get the HPV vaccine, which is highly effective at preventing cervical cancer. The other reasons would be not going in for a Pap smear or not getting timely follow up after an abnormal result is communicated.

What infrastructure or education needs to be in place for self-swabbing programs to succeed at scale?

I think we're going to find that out in the next few years, because we really haven't had a real-world setup for this type of treatment.

For example, if you introduced this program to people who are homeless, how do you follow up with them? That is going to be an issue that is going to have to be addressed.

The more insurance types that cover it, the more ways you're going to have to have for people to come in afterwards for a follow-up visit, pick up the self-swabs, or have it mailed to them—but none of this has been done on a large-scale basis yet.

Could you envision something like this being released at community health clinics?

Absolutely. I think we will see these programs rolled out in the community health clinics. Patients will come in and get the test, just like they come in and get a Pap smear. Some of them will elect to do the self-swab, even though they're in the clinic. There could be a way that people could just pick up swabs, or perhaps the swabs could be mailed out.

It's not an immediate test result. It must be sent in for testing, and it would take a week or two to get results.

What is one message that you want patients to take away about HPV prevention?

I think the biggest message would be, even though these self-swabs are going to allow you to do it yourself, a follow-up appointment with the clinic or doctor is going to be extremely important. It all falls apart if you don't come back in if you have an abnormal result. There are still 4,000 deaths a year in the United States from cervical cancer, so there are a lot of people that either don't go in at all or don't go back if they have an abnormal result. Just being tested is not enough to prevent the cancer.