Screen it loud and clear: At-home urine tests for HPV could be the key to preventing cervical cancer
September is Gynaecological Cancer Awareness Month: an opportunity to increase awareness of cancers of the cervix, endometrium, ovaries, vagina, and vulva. Eloise Hunt, MSc Science Communication Student, speaks with Dr Jen Davies-Oliveira about the importance of early detection research in HPV.
The importance of early detection
It probably brings relief to most that smear tests are only a three-yearly occurrence. The use of a speculum can indeed be very uncomfortable, but the intimacy of the examination can also be extremely off-putting.
A smear test is a medical examination of the cervix that primarily tests for a virus called Human Papillomavirus (HPV). It is a common, sexually transmitted virus responsible for up to 99% of cervical cancer cases worldwide. There are 3,200 cases of cervical cancer in the UK every year and mortality is almost always preventable.
HPV screening is offered to every woman between the ages of 25 and 65, every few years. However, uptake of screening is at an all-time low with only 72% of those eligible attending their smear tests, leaving almost a third unscreened. In addition, early detection is key not only in survivorship but also financial efficiency: improving cervical screening rates could save the NHS £10m a year.
Accessible screening for all
Dr Jen Davies-Oliveira is working on ground-breaking research into the prevention and early detection of cervical cancer by exploring the possibility of HPV testing of a urine sample as an alternative to a smear for cervical screening. Jen is a trainee in Obstetrics and Gynaecology with an interest in pursuing a career in Gynaecology Oncology and is a published first author. She is undertaking her PhD alongside renowned Professor of Gynaecology Oncology Emma Crosbie, who is “a key inspiration” for her.
Urine testing is non-invasive, simple and can be done quickly at-home and sent back to the testing lab by post. Jen hopes that this test will match the effectiveness of the ‘gold standard’ cervical smear test at detecting the virus. If this proves to be the case, we could see a transformation in our cervical screening program, hopefully becoming more efficient and increasing the number of people screened as the testing becomes more tolerable and accessible.
“If it can [detect HPV] to the same extent that a cervical sample can, then why would we need to have an invasive procedure if we can just give a urine sample.”
Due to the sub-optimal uptake of cervical screening, it is important to overcome the barriers that non-attending women face and “one of the big barriers is an intimate examination that can be very uncomfortable… also people find it can be inconvenient; we all have busy lives… or they just don’t find the time.” It is hoped that these perceived barriers “would be negated with a urine test”.
One of the big barriers [of the smear test] is an intimate examination that can be very uncomfortable… also people find it can be inconvenient; we all have busy lives… or they just don’t find the time.
Dr Jen Davies-Oliveira
Trainee in Obstetrics and Gynaecology
Unfortunately, lower screening rates are found within marginalised communities including the LGBTQIA+ community. Jen is currently exploring the acceptability of a urine test instead of a smear for individuals within the LGBTQIA+ community who are eligible for screening. This will give us important information about how to improve cervical screening for individuals in this community.
Another concern is that individuals at 65 years old arbitrarily exit the cervical screening program. “The screening program stops at 65 years and your question would be: ‘Why, that must be based on science?’. No, it’s just historic as those who have screened adequately have a low risk of developing cancer. However, for those who have not attended screening – there is a second wave of cervical cancer in this age group”. In addition, it can be even more uncomfortable for older women to have a speculum examination post-menopause, “so I think these urine tests would be well-placed in this population”.
Jen is passionate about women’s healthcare and is driven by research that is relatable, accessible and has a clear clinical link. The connection to patients is a core component of her work and she has valued meeting all 333 of her participants so far. She is aiming to recruit 550 participants before the end of the year.
Finishing recruitment is key to assessing how effective a urine test is at detecting HPV by comparing this with the smear test. Jen also hopes to explore the possibility of reducing health inequalities and she is looking to carry out qualitative research to uncover the details of these inequalities, what barriers to screening still exist and what attitudes there are towards current and alternative screening strategies.
While urine tests for HPV have already shown promise, Jen aims to build on these findings and increase the effectiveness of these tests by optimising the urine samples for testing. She is experimenting with a funnel-shaped collection device with a preservative contained inside. This device allows users to collect a more HPV-concentrated sample easily at-home, so the test has a better chance of detecting the HPV if it is present.
The prospect of developing urine HPV screening seems hopeful, but in order to ensure a significant uptake of this new procedure, there must be widespread education about the tests themselves and about the risks of missing screenings. When vaginal self-swabbing was offered in Australia alongside smear tests, coverage only increased by an extra 6%. “While that’s a good start, you definitely want to get higher numbers than that.”
*Image: Poster for ACES-LBTM+ (A SUBSET OF THE ACES study)