Impact of a Clinic- and Mail-Based Cervical Cancer Human Papillomavirus Self-Collect Screening Program

Virtually all cervical cancers are caused by high-risk human papillomaviruses (HPVs), which can be accurately detected using deoxyribonucleic acid (DNA) testing from cervical or vaginal samples. Patient vaginal HPV self-collection (HPV self-collect) presents new opportunities to expand access to cervical cancer screening, improve uptake, and reach underrepresented populations. An integrated health system in Washington State implemented a mail- and clinic-based HPV self-collect program. Researchers partnered with health system leaders and clinicians to evaluate program implementation. This report describes the program, evaluation methods, challenges encountered, and proposed solutions. Primary outcomes observed after program implementation included increases in cervical cancer screening uptake, reduction in pelvic examination utilization, and generally positive clinician response based on interviews and site visits. Eligible participants were individuals with a cervix, 30-64 years of age, at average risk for cervical cancer, and due or overdue for screening. During the prelaunch period (July 1 to December 31, 2022), 48,511 individuals were not current with screening. In the postlaunch period (October 1, 2023, to March 31, 2024), 47,333 individuals were not current with screening. Screening completion was statistically significantly higher in the postlaunch period, with an unadjusted mean difference of 2.2 percentage points, even though only 5963 of 47,333 (12.6%) eligible individuals were mailed HPV self-collect kits, with 1494 (25.1%) returned and processed during the 6-month postlaunch period. Pre program, all cervical cancer screening (100%) consisted of cervical samples collected by clinicians during pelvic examinations, whereas post launch 62.6% were clinician-collected and 37.4% were vaginal self-collected HPV tests. Key lessons included the need for clear documentation and quality assurance procedures to identify eligible individuals and distribute mailed HPV self-collect kits, as well as standardized workflows for in-clinic distribution. Site visits and interviews revealed that clinicians generally appreciated the program - some noted that it changed their practice by reducing time spent on pelvic examinations, allowing more time to address patients' other health issues - and reported that patients found it acceptable or preferable. However, concerns were raised by clinicians and by patients to their clinicians about screening quality, and clinicians had knowledge gaps regarding the accuracy of both primary HPV screening and patient-collected samples. Iterative sharing of evaluation goals and findings between researchers and health system leaders led to program improvements and identified further opportunities for strengthening implementation. As of December 31, 2025, 60,529 HPV self-collect kits have been mailed, with 13,317 (22.0%) completed, and an additional 12,014 HPV self-collect tests completed at clinic visits. HPV self-collect provides an opportunity to efficiently screen more people for cervical cancer and potentially increase primary care access.