Charna Albert
May 2026—Two years after the Food and Drug Administration approved the first HPV self-collection devices, physicians and cervical cancer prevention advocates are debating the best use for the new screening option.
Take Alabama, which has one of the highest cervical cancer incidence and mortality rates in the U.S. It adopted in 2021 a comprehensive statewide cervical cancer elimination plan, a collaboration between the University of Alabama at Birmingham, Alabama Department of Public Health, Rotary Club of Birmingham, and other civic organizations. Its leaders consider the FDA approval a win.
“It’s an incredible achievement to do this, and the amount of work spent on self-collection worldwide is significant,” says Warner Huh, MD, MSHA, chair of the UAB Department of Obstetrics and Gynecology and a leader of the initiative, known as Operation Wipe Out. Yet for now, Operation Wipe Out isn’t directly promoting self-collection.
Dr. Huh’s main reservation about self-collection is the message that’s sent to underserved patients when screening is possible but follow-up care is not. “Let’s say you have a community of women who don’t have access to Ob-gyn [care]. They do self-collection and send it in, but no provider is willing to see those patients because they’re uninsured or underinsured,” Dr. Huh says. That’s true of other cancer screenings provided at no or low cost, he concedes. “It’s true for mammography. It’s true for PSA screening. It’s true for everything we do.” But with self-collection, held up as a low-cost and convenient option, he and his colleagues are wary of overpromising and underdelivering.
“I’m concerned we’re going to have women with identified abnormal [results] and they can’t get evaluated and they wind up getting cancer anyway. And I think we’ve made the problem worse, not better, in some ways.” The patient will see it as, “I got screened and it didn’t help,” Dr. Huh says.
Isabel Scarinci, PhD, MPH, a behavioral scientist and Operation Wipe Out leader, says it’s important to manage expectations, especially given their partners outside health care. “If you create an expectation that’s not realistic, you kill your effort immediately,” says Dr. Scarinci, vice chair of global and rural health, Department of Obstetrics and Gynecology, UAB Heersink School of Medicine. The Operation Wipe Out stance may shift if self-collection becomes readily available in the home (as of now, only one device, the Teal Wand, is FDA approved for home use). “But we are not pushing it until we figure out these other downstream issues.”
What’s more, most people aren’t well educated about HPV and its connection to cervical cancer, which poses its own problems for cervical cancer prevention outreach.
“We have made substantial medical progress,” Dr. Huh says, in screening modalities, follow-up, management, and treatment. “But we’re still not doing a very good job explaining to women and the community why they need to be screened, at least in rural communities.” Physicians aren’t necessarily aware of how little patients know, he says. “We still have a tremendous way to go to educate women, and we think we’re doing it but we’re not, particularly for the women most vulnerable and at highest risk for cervical cancer.” Nor does he think it realistic to expect more from overburdened clinicians. “There’s only so much teaching you can do under the current health care system,” he says. “And you can only see the people that you see. What about all the women who don’t get screened that you don’t see? How do doctors educate that group?”
To other physicians, however, self-collection offers just such an opportunity.
Guang Fan, MD, PhD, chair and professor of pathology and laboratory medicine at Oregon Health and Science University School of Medicine, and her colleagues in the department, received grant funding from the CAP Foundation in 2025 to hold See, Test and Treat programs, where they performed HPV testing using self-collected samples and partnered with health workers and health centers in the community to educate patients about HPV and cervical cancer. (OHSU has also implemented self-collection in its primary care clinics, where it now accounts for about five percent of HPV testing.)
Vanderlene Kung, MD, PhD, associate professor of pathology and co-lead pathologist for the See, Test and Treat Foundation grant, says patients at these events have been curious and eager to understand more about the testing. Without the pelvic exam, she and others have time for “culturally tailored patient education and opportunities for patients to ask questions before and after self-collect,” Dr. Kung says. The department’s diversity, too, is a plus, she notes. “There are Chinese speakers and Spanish speakers on our faculty, and that cultural and language fluency has changed outreach efforts.”