PHOENIX – Dr. Gail Petersen Hock was making dinner for her family on a Friday night in 1982 when her OB-GYN called her.

“He said, ‘I want you to sit down,’” she recalled. “‘We found cancer in your cervix, and you need to have surgery next week.’”

“It was a surprise to me,” she said.

Petersen Hock, 69, was 27 at the time of her cervical cancer
diagnosis, and her treatments lasted for almost two decades. She counted
herself lucky.

“I had biopsies every six months until I was well into my 40s,” she
said. “And I was treated with TCA (tricarboxylic acid), which is very
strong acid, at one point after I was 40 years old – and haven’t had a
problem since, but I am one of the lucky ones.”

Because of her experience, Petersen Hock is committed to decreasing
cervical cancer incidence rates through education about screenings and
related vaccinations, serving as the co-leader of the Arizona chapter of
the National Cervical Cancer Coalition. She and other health providers
hope the new Food and Drug Administration-approved cervical cancer
self-test will make screenings more accessible and decrease cervical
cancer rates.

On average over 200 women in Arizona are diagnosed with cervical
cancer every year, according to 2016-2020 data from the National Cancer
Institute and the Centers for Disease Control and Prevention.
Nationally, the cervical cancer five-year survival rate is 67%,
according to NCI data.

However, according to Dr. Sharon Thompson, CEO and primary physician
at Central Phoenix Obstetrics & Gynecology, cervical cancer is
preventable through proper screening.

“There are precursors to cervix cancer that don’t just arise out of
the blue,” she said. “You have changes that happen in the cervix before
you get to cancer, and if we can detect those changes and treat them,
then we can prevent cervical cancer.”

To detect cervical cancer, people are screened with a Pap smear or
human papillomavirus (HPV) test because most cervical cancers are traced
back to an HPV infection. During these tests, a clinician uses a
speculum to hold the vaginal walls open and takes a sample of cells from
a patient’s cervix using a brush, a process that can be uncomfortable.

With the self-test, a patient would insert a cotton swab or similar
instrument into the vagina to take the collection of cells. The
collection is done in a clinic, and the clinician sends the sample to a
lab.

“Pretty much if you can access your vagina or someone can, you can
get the appropriate swab,” Thompson said. “It doesn’t have to go
anywhere specific because we know that the entire vagina will contain
the sampling that we need.”

This technology isn’t new for providers like Dr. Caitlin Lee, the
medical director of quality and director of health equity at Wesley
Community and Health Centers.

“It’s something that even though it’s kind of an off-label use, we
have used,” she said. “I actually just got a result back on a patient
this morning for a cervical cancer screening that I had a patient do a
self-collected swab on last week in clinic because of the history of
trauma.”

After getting results from the lab, a doctor would contact the
patient. If further testing is needed, such as after an abnormal
specimen is detected, the doctor would explain what follow-up care could
look like. But, ensuring that a patient receives the appropriate
follow-up care is a concern for some providers.

“What happens if someone has a positive result?” Thompson said. “If
these tests are for people who don’t have access to care, then what
happens once they get an abnormal Pap? Are they going to be able to
access the follow-up that they need?”

“The responsibility falls on the person who needs to have the
screening or the return to care,” said Petersen Hock, who ran a Title X
clinic in Phoenix and worked as an advanced practice public health
nurse. “I can’t tell you how many times I have written on a chart ‘lost
follow up;’ it’s not an uncommon situation.”

In Wesley Community and Health Centers clinics, a cervical cancer
self-test would integrate well into its current follow-up system.

“We already have programs in place to make sure that when patients
have abnormal cervical cancer screenings, we’re able to get them in for
the follow-up to do the appropriate diagnostic testing and treatment if
they need it,” Lee said. “I think if there are other primary care
clinics that aren’t doing a lot of their screening already, that they’re
more used to sending it off to a specialty clinic, then they might need
to make some adjustments to workflows.”

Barriers to care persist even with a self-test. Under current
guidelines, a patient would still need to make an appointment at a
clinic to do the self-test, which can limit accessibility.

“You still have to get to the doctor’s office, and you have to be able to get them in the door to do it,” Lee said.

“The appointment still has to be made,” Petersen Hock added. “The
person still has to travel to the clinic, get the child care if they
have children, and also have the anticipation of having a screening that
is related to cancer.”

Other barriers to testing can include cost, locality of clinics,
insurance status, education level and whether a person is comfortable in
a clinical setting. Those with a history of trauma, especially sexual
trauma, may be more hesitant to be screened for cervical cancer because
of the invasive nature of the Pap test. Providers are hopeful that
self-testing can help break down some of these barriers to care for
underserved populations.

“I always hope that when we have a test that requires less, that
provides less barriers … it will reach the folks we want it to,”
Thompson said. “We assume it’s (the self-test) going to increase access,
but it only will if we think about what the barriers to access are and
help people get over those.”

Wesley Community and Health Centers is all about creative solutions to break down barriers to access, Lee said.

“There’s a lot of room for creativity,” she said. “On the mobile
clinic, some of our providers, that’s primarily where they do care. And I
think the self-collection kits have a big role for those populations as
well, especially people experiencing homelessness. … I think that the
opportunity to expand reach on a public health level is so much greater
with this approach.”

Though the current guidelines dictate that the self-tests can only be
done in a clinical setting, providers believe the test will increase
accessibility to cervical cancer screenings.

“These tests, because they work with either a Q-tip swab or a device
that looks like a tampon applicator, they’re great for women who might
come into the office, but you can’t get a Pap done,” Thompson said.
“Someone who had trauma or someone who has a different ability in terms
of their use of their legs and hips … now you can get a collection on
folks like this, who previously, it was very difficult to put a speculum
in and get their feet up in stirrups, etc.”

Lee anticipates the self-administered tests to be available at
clinics in late summer or early fall with expectations of an
FDA-approved at-home test coming down the road.

Overall, providers say there is hope for global change in cervical cancer screening and incidence rates.

“Cervical cancer and death is very, very real,” Petersen Hock said. “I think it could be life-changing around the world.”