Getting physicians to accept home-based self-collection is an ongoing process, she says. One problem is primary HPV screening isn’t universally accepted despite all leading guidelines citing it as the preferred screening option. Some physicians still insist on the Pap test when patients bring them Teal Health results. And in some instances, she’s connected patients without a primary care provider or Ob-gyn to follow-up care, only to have that physician insist the patient start over with repeat HPV/Pap testing instead of initiating guideline-based triage.
“There’s going to be some bumps in the referral process for these patients sometimes, because of that lack of acceptance,” she says. She doesn’t fault any of these physicians, she notes. “This is something very new.” And some may be wary of tests ordered online, given that direct-to-consumer HPV tests with dubious regulation and oversight have been available for some time. “I have always discounted those as a practitioner, and I think it’s hard for them to see this as something different without doing a lot of research.”
It isn’t rare for physicians to diverge from the screening guidelines, Dr. Swenson says. “I’m finding there’s so much disparity in the guideline following out there,” she says. “It’s remarkable.”
At UAB, Dr. Scarinci and Dr. Huh and their colleagues delved into the physician perspective on the transition to primary HPV testing in a recent survey of community-based Ob-gyns (Ketch PW, et al. J Low Genit Tract Dis. Published online March 16, 2026. doi:10.1097/LGT.0000000000000942). They interviewed in 2024 10 physicians who described differing adherence to evolving guidelines. Some were still doing annual cytology for simplicity’s sake, fear of underscreening, or in response to the perceived preferences of patients who may be dissatisfied with or distrusting of recommendations for longer screening intervals. The inconsistency in guideline following contributes to patient confusion and anxiety, the authors write, especially for patients accustomed to annual Pap testing or who have never undergone HPV testing.
Dr. Lu, of OHSU, would agree. She also believes the screening and management guidelines should be standardized across guideline-setting organizations. “Variability across organizations adds complexity for both providers and patients,” she says. “The priority should be consistent, accessible screening and early detection, supported by clear and unified recommendations.”
What would it take for Operation Wipe Out’s leaders at UAB to promote self-collection?
“I’ll be very concrete,” Dr. Huh says. “If we can figure out a way to triage women with screen positives and send those patients for a colposcopy, and then help figure out how they get treated if they have a severe abnormality—and do it with some level of consistency—that’s the win. And that’s where Operation Wipe Out can help, in conjunction with the Alabama Department of Public Health. They understand the barriers, challenges, and needs.” In fact, one of the initiative’s most successful interventions to date is a program in which the ADPH trains nurse practitioners to perform mobile colposcopies in underserved, rural areas of the state.
Any success they have, however, will be driven by the relationship with the public health department, he reiterates. “That’s the lesson I’ve learned from Operation Wipe Out.” Without that alliance, “you’re not going to get where you need to be. It’s almost obstructionist, in my view.”
Adds Dr. Scarinci, “Cervical cancer is a disease of poverty. At the end of the day, the burden is going to fall on the public health system.”
What message do they have for pathologists like Dr. Fan and her team?
“They’re in the chain of custody,” Dr. Scarinci says. “They’re a piece of the puzzle, and we need their voice.” The laboratory side, she imagines, has solutions to share “that we have never thought about.”
That is certainly Dr. Fan’s view as she shares her future plans with hospital leaders and other stakeholders. Her next intervention target is phlebotomy. “When patients come to phlebotomy for other things, we can say, ‘You’re due for your cervical cancer screening. Do you want to go collect and leave the swab here?’”
With a little support, she says, they’ll get it done.
Charna Albert is CAP TODAY senior editor.