Their pathology expertise is also an asset. “We’re experts in HPV testing,” says Zhengchun Lu, MD, PhD, co-lead pathologist with Dr. Kung of the STT Foundation grant and molecular genetics fellow at OHSU. “This enables us to communicate clearly with participants about test reliability and clinical meaning, building trust and understanding.”
Dr. Fan and her team have applied clinical judgment as needed at the outreach events. In one instance, a patient just over age 65 expressed interest in self-collection. Because she was outside the age range recommended by the guidelines for HPV screening, Dr. Lu hesitated. In talking to the patient, though, she discovered the patient must be long overdue for screening and decided to proceed. The patient had a positive test and was connected to follow-up care, she says.
The pandemic had a hand in inspiring Dr. Fan and her team. As Oregon reopened, Dr. Fan says, the OHSU pathology department assisted with mobile SARS-CoV-2 testing and eventually led the state’s back-to-school testing, running more than 10,000 tests a day. “That embedded the idea,” she says. “How can we be more scalable for cancer screening? How can we be more automated?”
“This is one example of how pathologists can be out there,” she adds. “It’s a major opportunity for pathology to lead in prevention and population health.”
Dr. Fan and her colleagues described their use of HPV self-collection for cervical cancer screening in an article published recently (Lu Z, et al. Arch Pathol Lab Med. 2025;150[4]:284–291). They described it as the first academic center-led implementation of FDA-approved self-collection in U.S. community settings.
They recruited 156 participants ages 25 to 65 in 2024 and 2025. After instruction by pathologists, participants collected vaginal samples with the Copan FloqSwabs 552C.RM. These were transferred to ThinPrep media for HPV testing on the Cobas 8800 system. Post-collection surveys assessed user experience with self-collection. Of 129 respondents, 117 found the self-collection kit easy to use, 114 would recommend it, and 91 were likely to choose self-collection over clinician-collected samples for future testing. The reported benefits: convenience, comfort, and privacy.
All 156 HPV tests were valid. Ten of the 156 patients were HPV positive: one for HPV18 and nine for other non-16/18 high-risk HPV types. Three patients tested in outreach events early in the study period completed follow-up cytology; two were negative and one had atypical squamous cells of undetermined significance. At the time of publication, the other positives were pending follow-up. Now, Dr. Lu tells CAP TODAY, all but one participant who couldn’t be reached despite multiple attempts have completed follow-up cytology. “This highlights both the success of our follow-up efforts and ongoing challenges in patient engagement,” she says.
The high proportion of non-16/18 types among the positive cases echoes an earlier retrospective analysis at OHSU of HPV genotyping and cytology data (Lu Z, et al. Diagnostics [Basel]. 2025;15[4]:419). Among 574 patients who underwent cotesting and a subsequent biopsy, HPV was positive in 455 cases, of which 283 were non-16/18 types. About half the cases with only HPV16 or 18 positivity were negative for cervical intraepithelial lesions on biopsy. Of the cases with non-HPV16/18 high-risk HPV, 48 (17 percent) had CIN3/HSIL in biopsy specimens. And of all the cases with CIN3/HSIL on biopsy, 50 percent had a high-risk strain other than HPV16 or 18. “Our outreach data showed a similar trend,” Dr. Lu says. “This underscores the importance of broad HPV testing beyond just types 16 and 18.”
The HPV vaccine likely played a minor role in the frequency of non-16/18 types in both data sets, Dr. Kung says. “With Gardasil in the U.S., the frequency of 16/18 is shifting in the younger population.” Vaccine uptake, however, is only moderate. “Also, there’s a much older population that missed that vaccine window.”
The other high-risk HPV types appear to be more common in the non-white population, “at least from our data,” Dr. Fan says.