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Screening for human papillomavirus (HPV) strains that cause cervical cancer can be difficult for many women, but this is not the case being tested can have fatal consequences. In 2019, approximately 4,250 women will die from invasive cervical cancer – a figure that, notes the American Cancer Society, has not changed much in 15 years. To reduce this number, some companies are trying to introduce HPV testing in doctors' offices and women's homes.
"Half of the cervical cancer cases that continue to occur in the United States involve women who are screened infrequently or have never been screened," says Vikrant Sahasrabuddhe, program director at the United States. Cancer Prevention Division of the National Cancer Institute. In particular, a 2017 report from the Centers for Disease Control and Prevention (CDC) found that rural areas had higher rates of cervical cancer than their urban peers, despite an overall incidence of cervical cancer. lower cancer.
For Jessica Horwitz, director of clinical development at Nurx telemedicine company, there is a simple solution to this persistent problem: to allow women to test themselves at home. After successfully using the telemedicine model to improve access to birth control and drugs that reduce the risk of HIV infection (also called Truvada or PrEP), Nurx has recently launched a new health care service. home HPV test that should be relatively easy for patients. use.
"This is a vaginal cotton swab," Horwitz explains by phone, noting that after cleaning the vagina by the user, he is asked to break the tip of the cotton swab, to insert it into a container provided with the test kit and send it back by post. at Nurx for analysis.
Screening for sexually transmitted infections (STIs) at home has been part of the reproductive health landscape for years: in 2012, the Federal Drug Administration (FDA) approved a home version of the OraQuick oral tampon HIV test, allowing consumers to quickly determine their HIV status in the privacy of their own home. Similar home-based tests are marketed for other STIs, including chlamydia, gonorrhea and trichomoniasis. Although not all home tests provide the instant results generated by OraQuick (many home tests, including the Nurx-distributed HPV test, require the user to send the kit to a lab for testing purposes ), but they are all guaranteed. discretion and flexibility, which, according to Nurx, will attract clients who would otherwise have been screened for cervical cancer.
Nurx is one of many companies embarking on the HPV testing space. Let us check, Everly Well, Private iDNA and Self Collect are among Nurx's competitors in the home testing market. In countries such as Canada, Australia and the Netherlands, self-tests have been available for several years.
These home screenings are however not without risks. A mistake by the user can lead to false negatives. "Someone who gets a negative result from the doctor's office, it's guaranteed," says Sahasrabuddhe, but with a home test, the uncertainty is heightened. In the case of a false negative, a person who fails to pass the test with confidence for several years only discovers cervical cancer once it is too late to treat it effectively. But Sahasrabuddhe is quick to note that there is not enough data to assess whether false negatives are a major problem.
In addition, home screenings are not a panacea in themselves. If a person presents a positive result for one of the HPV strains causing cancer, the test will not prevent it from developing cancer. For this, patients will have to pass follow-up tests and, possibly, colposcopy, biopsy and removal of any abnormal cells found on the cervix of the uterus. But Horwitz hopes it will serve as a point of entry for care – a goal that Nurx will be happy to facilitate. "We have a very strong nursing team with a large network of referrals," says Horwitz. "If someone has a positive HPV test, they will do everything in their power to find someone in their community to whom they can refer for personal care."
And when a referral is not possible – perhaps because the person lives in a place far away from Nurx's referral network – "the worst result is that you have given somebody the power and information, "says Horwitz.
For health professionals, HPV home screenings, as well as other home-based STI testing, offer the potential to expand reproductive health care to populations that currently do not have access to it. . Hopefully, this will further reduce rates of cervical cancer and other diseases along the way. "From a public health perspective, we recognize the importance of bringing in women who would otherwise be missing," says Sahasrabuddhe, a point on which Horwitz strongly agrees.
"If traditional physical medicine met the needs of every woman in America, home HPV testing would not have to be a thing," says Horwitz. "But it's not."
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