The paper gown. The cold stirrups. The clanking sound of some medieval instrument adjusting in the sacred spaces of our body. For decades, these have been the unavoidable, universal rituals of cervical cancer prevention. The Papanicolaou (Pap) smear was a 20th-century public health triumph, driving down mortality rates and saving millions of lives. But in the 21st century, this traditional, clinic-bound model has hit a ceiling—and it is leaving our most vulnerable behind.
Cervical cancer is highly preventable and entirely curable when caught early. Yet, a diagnosis today represents a profound failure of our healthcare system. The collateral damage is devastating: as I shared during the September 17 congressional briefing on cervical cancer elimination, for every 100 cancer deaths in affected populations, an estimated 121 maternal orphans are left behind. When a mother dies, the ripple effects fracture families and destabilize entire communities. Tragically, this loss of guardianship often becomes a matter of child survival; in some regions of the world, for every 100 women who die from breast or cervical cancer, between 14 and 30 children will subsequently die as a direct result. Eliminating cervical cancer is fundamentally a child survival strategy.
Beyond the human devastation, we must confront the staggering macroeconomic toll here in the United States. The premature death of women from cervical cancer translates into a massive destabilization of the U.S. economy, driven by lost workforce productivity and extreme healthcare costs. The direct and indirect economic burden of cervical cancer in the U.S. is estimated at $3.3 billion annually. The premature loss of women to this disease removes tens of thousands of individuals from the workforce, resulting in an estimated $2.19 billion in lost earnings in a single year. Furthermore, the total annual direct medical cost for all HPV-attributable disease in the U.S. exceeds $9 billion, and within that expenditure, nearly $1 billion is spent annually just on treating invasive cervical cancer—a late-stage cost that could be averted through earlier intervention.
Through my clinical work as a gynecologic oncologist and my research leading Population Sciences and Prevention at the University of Cincinnati Cancer Center, I see exactly why the status quo is failing. We operate mobile health platforms and pilot programs that meet patients in emergency departments and community settings, and the takeaway is always the same: People are not avoiding their health. They are trying to operate within a system that ignores the realities of their lives.
The traditional screening model assumes that a patient has the luxury of time to take off work, secure childcare, and access reliable transportation to a specialist. It ignores profound geographic and socioeconomic hurdles. Equally important, it overlooks the deeply personal, psychological barriers that are too often stigmatized. For many people—particularly those with a history of trauma, prior distressing medical experiences, cultural reservations, or physical disabilities—a pelvic exam is a source of deep anxiety. When we demand someone scale these compounded obstacles just to get in the door, we fail them.
The paradigm shift
This is why HPV self-collection has the power to fundamentally transform preventative care. We are no longer limited to scraping cells to look for abnormalities; we can screen directly for the Human Papillomavirus (HPV) that causes them. With the recent FDA approval of HPV self-collection, the power dynamics of pelvic health are shifting.
Self-sampling allows an individual to collect their own specimen using a simple swab in the privacy of their own home, a mobile clinic, or a convenient community location. Research has consistently shown that self-collected samples are highly accurate, and more importantly, they actively remove the intimacy-related and structural barriers that prevent people from participating in regular screening programs. It bypasses the need for an immediate in-office pelvic exam, reserving clinical intervention—such as a pap test or colposcopy—only for those whose samples detect high-risk HPV genotypes. We are destigmatizing the screening process by giving patients back their bodily autonomy.
A crucial tool, not a replacement
However, it is crucial to understand what this innovation represents: HPV self-collection is a vital tool in our prevention chest, but it is not a wholesale replacement for comprehensive clinical care.
I am not advocating for patients to break up with their gynecologists. Routine, in-person visits to a healthcare provider remain indispensable for holistic well-being. A self-administered swab is incredibly effective at screening for a specific virus, but it cannot detect the myriad of other reproductive, pelvic, or systemic health issues that a physician evaluates during a comprehensive exam. There are very real, life-altering conditions that can be missed if individuals completely opt out of the clinical setting. Rather than replacing the doctor’s visit, self-collection serves as a critical entry point for those who might otherwise receive no screening at all, bridging the gap between marginalized patients and the healthcare system.
Moving from innovation to eradication
Realizing the full potential of at-home and self-collected testing requires policymakers and healthcare leaders to modernize our infrastructure. During the recent congressional briefing, we laid out several non-negotiable steps to ensure equitable adoption:
- Expand the safety net infrastructure. We must aggressively advance legislation, including the reauthorization of the CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Expanding this infrastructure is critical for communities that lack immediate access to specialists.
- Solve the logistical economics. Currently, the absence of specific postal shipping codes shifts the cost of mailing self-collection kits onto the senders or public health programs. We cannot allow basic postal costs to become a bottleneck to a life-saving screening program. A postage stamp should not dictate someone’s cancer risk.
- Reimburse for patient navigation early. Patient navigators should be available to guide individuals through the terrifying labyrinth between a positive screen, diagnosis, and treatment. Right now, they are typically reimbursed only after an invasive cancer diagnosis. A positive HPV self-swab means a patient must return to a clinic for follow-up care. Reimbursing for navigation during the early screening and diagnostic phases ensures people do not fall through the cracks.
Whether we are looking at the survival of orphaned children in global communities or the billions of dollars in lost earnings and healthcare expenditures here at home, the conclusion is the same. The failure to eliminate cervical cancer places an unbearable tax on the next generation. Investments in early intervention, comprehensive screening, and primary HPV testing are essential to securing the economic and physical health of our families.
References
- Clay, P. A., Thompson, T. D., Markowitz, L. E., et al. (2023). Updated estimate of the annual direct medical cost of screening and treatment for human papillomavirus associated disease in the United States. Vaccine, 41, 2376-2381. https://doi.org/10.1016/j.vaccine.2023.02.049
- Gupta, S., Palmer, C., Bik, E. M., et al. (2018). Self-Sampling for Human Papillomavirus Testing: Increased Cervical Cancer Screening Participation and Incorporation in International Screening Programs. Frontiers in Public Health, 6. https://doi.org/10.3389/fpubh.2018.00077
- Nwankwo, C., Corman, S. L., Shah, R., & Kwon, Y. (2019). HSR19-102: Direct and Indirect Economic Burden of Cervical Cancer (CxCa) in the United States in 2015: A Mixed-Methods Analysis. Value in Health, 22, S407.
- White, K. E., Trogdon, J. G., Petersen, R., et al. (2022). The Economic Burden of Maternal Mortality in the United States. Women’s Health Issues.
- Mailhot Vega, R.B., Balogun, O.D., Ishaq, O.F., Bray, F., Ginsburg, O. and Formenti, S.C. (2019). Estimating child mortality associated with maternal mortality from breast and cervical cancer. Cancer, 125: 109-117. https://doi.org/10.1002/cncr.31780
- Galukande M, Schüz J, Anderson BO, et al. Maternally Orphaned Children and Intergenerational Concerns Associated With Breast Cancer Deaths Among Women in Sub-Saharan Africa. JAMA Oncol. 2021;7(2):285–289. https://doi.org/10.1001/jamaoncol.2020.6583
