Are we preparing for the future of cervical cancer prevention?

Monday, August 29, 2022.

On June 25, 2022, I wrote this:

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Over a decade ago, I saw a big problem approaching. With one round of screening with HPV DNA testing having been found superior to cytology (pap smear) and Visual Inspection with Acetic acid (VIA) in preventing cervical cancer, it was clear that the world was going to move towards HPV testing in cervical precancer screening. I predicted that HPV testing was increasingly going to be simple, and at a point be as simple as performing a pregnancy test, with women doing this themselves. I still believe in this. As a ‘prophet of doom,’ my prediction continued that ‘In future, the problem will not be the testing, but the follow up and management of high risk HPV positives. It is necessary to train health workers to manage screen positives and precancer otherwise we are going to create chaos and anxiety.’*

*This is where we are. The Covid-19 pandemic had its positives. Many institutions in low resource settings including Ghana acquired PCR machines for Covid testing. Now these machines are being used for other tests including HPV DNA testing. Many laboratories are cashing in on running the tests. We are getting many women who test positive for high risk HPV. There are few health workers who can properly triage the screen positives and treat those with cervical precancer.
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The next day (June 26, 2022), the CEO of Atila Biosystems (which produces the AmpFire HPV detection system) responded that he might be able to get me the HPV test ‘as simple as a pregnancy test’ by the end of this year.

In the very near future, women will be able to perform cervical precancer screening tests at home (just like pregnancy tests or Covid tests, see images attached).

Important questions come up:

1. Are we building capacity to manage screen positives?

2. Who will the women who test positive consult?

3. Where will the women who test positive go?

4. What will be done for the women who test positive (to prevent them from developing cervical cancer)?

This is a good opportunity to prepare for the future.