"University of North Carolina Lineberger Comprehensive Cancer Center researchers have found that mailing selfcollection kits to test for highrisk human papillomavirus infection has the potential to boost cervical cancer screening  especially for lowincome women who are overdue for testing.  In the journal Obstetrics  Gynecology researchers published the results of mailing athome HPV selfcollection kits to  lowincome women in North Carolina who were overdue for screening according to national guidelines. They reported this screening approach detected highrisk HPV in all of the cases of women who were found to have highgrade abnormal cervical precancerous growths showing that selfcollection at home for HPV may be a viable method to identify women at highrisk for cervical cancer.  This is a demonstration that mailing selfcollection kits and returning them to test for highrisk HPV infection has big potential to increase screening access among underscreened women and to do that successfully said UNC Linebergers Jennifer S. Smith the studys senior author and a professor in the UNC Gillings School of Global Public Health.  Although cervical cancer is preventable through early detection and treatment the American Cancer Society estimates that more than  women will die from cervical cancer in the United States this year. Nearly  percent of women in the United States who are eligible for cervical cancer screening report they havent been tested for cervical cancer within the recommended time interval national surveys have shown.  Women are dying unnecessarily of cervical cancer because they either havent been vaccinated against HPV in adolescence or theyve not been getting screened according to national guidelines Smith said. Increasing screening rates among underscreened women is of paramount importance.  In  the U.S. Food and Drug Administration signed off on using an HPV test alone to screen for cervical cancer for women  years and older in conjunction with the Pap test. Earlier this year the U.S. Preventive Services Task Force gave an A rating to HPV primary screening alone for women aged  to .  There are a lot of different barriers that cause women to be underscreened said the studys first author Andrea Des Marais MPH project manager with the UNC Gillings School of Global Public Health. HPV tests are being widely used now in the United States but only through physician collection in clinical practice which requires that women come to a clinic. Offering HPV testing using selfcollection by mail has a lot of potential to reach women who are the highest risk of being screened those who dont access regular medical care.  For the study researchers mailed athome selfcollection kits to lowincome women in North Carolina who were overdue for screening by national guidelines. They included women between the ages of  and  years who had reported no history of receiving a Pap test which checks for precancerous or cancerous cells within the past four years.  Researchers provided study participants with selfcollection brushes along with instructions for how to take a sample from inside the vagina. The brush samples were then tested in a lab for HPV and other sexually transmitted infections. Participants also selfcollected samples at a clinic and handed them to a nurse and had a pelvic exam for a clinician to collect a Pap smear sample.  The researchers compared the results from self and cliniciansamples  which were tested for highrisk HPV strains that are linked to cervical cancer  to the Pap results and the results of cervical biopsies collected during colposcopy which is a secondary diagnostic test that confirms the presence of cervical precancerous lesions among women with abnormal Pap smear results.  The home selfcollection test indicated that . percent of women were infected with highrisk HPV the selfcollection tests used in the clinic found . of the women had highrisk HPV infection and the cliniciancollected test identified . percent of the women had highrisk HPV infection.  We found comparable detection between selfcollection and physiciancollection Des Marais said.  All women found to have highgrade cervical lesions by Pap smear or by cervical biopsy were positive for highrisk HPV on their home selfcollected sample.  We found in this sample all of the women who had highgrade lesions had HPVpositive home selfcollection results Smith said. We didnt miss any of those highgrade cases by conducting home selfcollection.  Smith said there is more work to be done such as identifying ways to make the selfcollection process more efficient and costeffective and getting FDA approval for the clinical use of selfcollection for cervical cancer screening.  This is a proofinprinciple study that we used to determine whether home selfcollection is highly effective for detecting highgrade disease Smith said. We are already working on the next step which is a clinical trial in which women who arent uptodate on screening get either a referral to a free clinic appointment to receive a screening or receive a selfcollection kit in the mail followed by referral to a free clinic appointment. This will allow us to determine the effect that selfcollection has on screening uptake.   In addition to Des Marais and Smith other authors included Yuqian Zhao Marcia M. Hobbs Vijay Sivaraman Lynn Barclay and Noel T. Brewer.  The study was supported by the National Cancer Institute the National Institutes of Health and the University Cancer Research Fund. Individual researchers were supported by the China Scholarship Council.  Financial disclosure Highrisk HPV and sexually transmitted disease tests sample preservation media ThinPrep processor slides and other equipment were donated by Hologic Inc. Selfcollection brushes were donated by Rovers Medical Devices. Some travel expenses for Des Marais were paid by Hologic and others have consulted for the company. Smith has received research funding supply donations and consultancies and served as a paid speaker for Arbor Vita BD Diagnostics Hologic Rovers Medical Devices and Trovagene. Neither Hologic nor Rovers had input into the research design analysis or interpretation of results."