Study Confirms Self-collection for HPV Testing may Improve Cervical Cancer Screening Rates Among Asian American Women

Research presented at the 18th AACR Conference on the Science of Cancer Health Disparities, held September 18-21, 2025, at the Hilton Baltimore Inner Harbor in Baltimore, Maryland, confirms that self-collection for human papillomavirus (HPV) testing may help improve the rates of cervical cancer screening among Asian American women.

Human papillomavirus (HPV) DNA testing is an effective method to screen for precancerous changes in the cervix.[1]

The authors of the study, which was funded by a National Cancer Institute (NCI) grant, noted that if Asian American women, among them Korean, Vietnamese, and Chinese, were given the option to collect their own sample for human papillomavirus (HPV) testing after an educational workshop, they completed cervical cancer screening at much higher rates compared with workshop attendees who were referred to clinics.

“HPV infection, especially with high-risk variants such as HPV16 and HPV18, is linked to essentially all cases of cervical cancer, and Pap smear tests can help identify women who might be at risk of developing cervical cancer,” noted Carolyn Fang, PhD, associate director for population science and professor in the cancer prevention and control program at Fox Chase Cancer Center – Temple Health, and the presenter of the study.

“But despite the disease being almost wholly preventable with current tools, some women are unable to benefit from traditional clinic-based cervical cancer screening,” Fang said.

Lower rates
“Rates of cervical cancer screening are lower among Asian American women compared with other populations, and our prior studies identified psychosocial and logistical issues as the top reasons,” Fang said.

According to Fang and her team, screening rates of clinic-based Pap and human papillomavirus (HPV) testing are suboptimal among Asian American women. The low participation in clinic-based cervical cancer screening is due in part to both psychosocial (e.g., embarrassment) and access factors (e.g., lack of transportation, limited English proficiency), which have been challenging to address with traditional screening interventions.[2]

Considering possible options to improve screening, the researchers hypothesized that self-collection of a vaginal sample for HPV testing could potentially offer a viable approach for overcoming these challenges.  To confirm this hypothesis, the researchers conducted a large-scale randomized trial to examine the effects of a community-engaged intervention on facilitating uptake of self-collected cervicovaginal samples for HPV DNA testing.

“Our goal was to evaluate whether offering women the ability to self-collect a vaginal sample for HPV testing would increase their participation in cervical cancer screening,” she added.

Study design
In the study, Fang and colleagues enrolled 1,140 Asian American women between 30 and 65 years of age (median age 52.5 years; SD=9.2 years); 99.8% of them were foreign-born, more than 55% of study participants had a high school education, and 47% had never had a Pap smear test.

The study participants attended a community educational workshop on cervical cancer and were randomized to receive either site referrals with free or affordable screening options (control, n = 588) or were then given HPV self-sampling kits with instructions in English, Korean, Vietnamese, and Chinese (intervention, n = 552).

Significant improvement
The option to self-collect a sample for HPV testing significantly improved completion of cervical cancer screening. Six (6) months after the workshop, 87% (480/552) of the women who received self-sampling kits returned a completed sample, whereas 30% (176/588) of those who were referred to a clinic had received a Pap test.

Approximately 14% (66/480) of self-sampled women tested positive for HPV. Nine percent (9%; 42/480) had high-risk HPV (hrHPV) variants, with an additional 5% testing positive for low- or intermediate-risk HPV strains. All participating women who tested positive for hrHPV received navigation assistance to follow-up care.

Enhancing participation
Based on the study’s outcomes, the researchers concluded that some clinic-based cancer screening interventions can indeed successfully reach underscreened women. However, various factors such as limited clinic hours, inconvenient locations, and transportation challenges continue to hinder access and screening uptake for many women.

Further, the researchers concluded that the results of self-sampling for HPV testing offer a
successful avenue to enhancing participation in cervical cancer screening among Asian American women. The outcomes also provide a pragmatic approach—a roadmap—to increase scalability across all populations living in under-resourced communities and regions.

“Our findings indicate that a targeted, culturally sensitive, convenient, and private option really appealed to women, and may help us get closer to the ultimate goal of eliminating cervical cancer,” said Fang, who noted that several professional organizations are now updating their guidelines to consider HPV self-sampling.

These conclusions confirm other studies demonstrating that HPV self-sampling kits are a feasible alternative to encourage and increase screening for cervical cancer in a population who might otherwise avoid this critical preventive examination due to embarrassment, discomfort, and anxiety.[1]

What’s next?
Moving forward, Fang and colleagues plan to investigate whether self-sampling will enhance women’s engagement with clinical care and screening over time, especially those who do not have a regular health care provider.

“By increasing women’s familiarity and comfort with testing, we hope to empower women to seek regular gynecologic care as well as reduce their anxiety and embarrassment associated with these procedures,” Fang said.

In addition to access to self-collection kits, Fang emphasized the importance of developing community-clinical linkages to ensure that women receive the appropriate follow-up when needed.

Study limitations
Limitations of the study include the lack of follow-up to determine whether women with high-risk HPV variants completed the appropriate care, and that only Chinese, Korean, and Vietnamese populations were included; therefore, the findings may not be generalizable to other Asian American groups.

Reference
[1] Nilyanimit P. Comparison of detection sensitivity for human papillomavirus between self-collected vaginal swabs and physician-collected cervical swabs by electrochemical DNA chip. Asian Pac J Cancer Prev. 2014;15(24):10809-12. PMID: 25605181.
[2] Xiong S, Ghebre R, Kulasingam S, Mason SM, Pratt RJ, Lazovich D. Exploring factors associated with preferences for human papillomavirus (HPV) self-sampling among racially- and ethnically-diverse women in Minnesota: A cross-sectional study. Prev Med Rep. 2023 May 13;34:102243. doi: 10.1016/j.pmedr.2023.102243. PMID: 37234567; PMCID: PMC10206196.

Featured image licensed under the Unsplash+ License. Used with permission.

DOI:10.14229/onco.2025.09.18.002