Self-Collection for Human Papillomavirus Testing in Clinical Settings: An Opportunity to Reflect on the Disconnect Between Guidelines and Clinical Practice.

Cervical cancer remains a preventable yet significant public health concern, particularly among rural, racial and ethnic minority, and LGBTQ+ (lesbian, gay, bisexual, transgender, queer+) populations who are more likely to be unscreened or underscreened. The recent draft guidance by the U.S. Preventive Services Task Force of human papillomavirus (HPV) self-collection for cervical cancer screening offers a transformative opportunity to overcome barriers to traditional cervical cancer prevention methods. Clinician collection and self-collection show strong agreement with HPV test results; however, clinician collection is still more sensitive than self-collection for CIN 2 or worse detection. Human papillomavirus self-collection at health care facilities, as recommended, addresses patient-centric challenges such as embarrassment, discomfort, and logistical constraints, thereby enhancing accessibility and engagement. Despite its potential, self-collection is currently approved by the U.S. Food and Drug Administration only for health care settings, limiting its reach and utility in underserved areas. To maximize the effect of self-collection, targeted educational campaigns for both clinicians and patients are essential to ensure proper utilization. At the patient level, strategies such as mobile clinics and mailed HPV testing kits could improve access, particularly among populations that, despite all other efforts, have not been reached. Clear guidelines at both the system and clinician levels regarding ordering responsibility, result notification for patients, follow-up protocols, specimen processing, and health insurance coverage at each step will be essential for successful implementation.