How cervical cancer home-test kits can end Pap smear pain and save more women’s lives

No woman I have ever met looks forward to getting a Pap smear, the standard test for cervical cancer. Asked whether they would rather see a dentist about a cavity, or a gynaecologist for a Pap smear, friends say they cannot decide which is less comfortable. Dr Lily Wong, a family doctor at The London Medical Clinic in Hong Kong, agrees that a “major barrier” to women getting Pap smears is the discomfort associated with the procedure. The Pap smear was developed by Dr Georgios Papanicolaou and first reported in 1928. It involves a gynaecologist taking a sample of cells from the surface of the cervix during an internal exam. Since its introduction, the Pap smear has saved hundreds of thousands of lives. That is because the sample reveals cellular changes that could indicate if a woman is in the early stages of cervical cancer. At the beginning of the 20th century, cervical cancer killed an estimated 24 to 37 out of every 100,000 women; in Hong Kong, that number has fallen to about four. Thanks largely to the Pap smear, the incidence of cervical cancer has decreased by a huge margin. And with the introduction of the HPV vaccine, women may become less susceptible to cervical cancer in the first place. HPV – human papillomavirus – is a common sexually transmitted infection that can cause cancer. The HPV vaccine is an excellent prophylactic. One large study showed that the cervical cancer risk among girls vaccinated before the age of 17 years was 88 per cent lower than among unvaccinated girls. However, there are many strains of HPV. Cervical cancer is caused by so-called “high-risk” types. The vaccine is protective against nine of these, most of them, but not all. And the vaccine is much more effective – 97 per cent effective – if given before the onset of sexual activity, which is why it should be given to girls, and boys, as young as nine. Stigma and taboo surrounding discussions of reproductive health can discourage individuals from seeking screening or talking about it openly Dr Lily Wong, The London Medical Clinic HPV has also been implicated in other cancers, including of the tongue, throat, tonsils, anus and penis, so it is good to vaccinate both boys and girls. Despite the campaigns around Pap smears and HPV vaccines, Dr Wong says too few women are aware of their importance in protecting against cervical cancer. The World Health Organization warns it is the fourth most common cancer in women globally, with over 660,000 new cases in 2022. A woman dies from cervical cancer every two minutes. Some studies found that around a third of all women fail to have routine Pap smears. And in Hong Kong, an upwards trend in diagnoses of cervical cancer over the past decade has been identified; in 2021, the Hong Kong Cancer Registry recorded 596 new cervical cancer cases. Nearly three-quarters of them were diagnosed between the ages of 25 and 64, and almost half were found at an advanced stage. Often, there are no signs or symptoms until cervical cancer has begun to spread. Cultural and societal factors influence the perception of Pap smears and cervical cancer screening in Hong Kong, says Wong. “Stigma and taboo surrounding discussions of reproductive health can discourage individuals from seeking screening or talking about it openly. Traditional views on modesty and privacy may also make some women uncomfortable discussing sexual health.” Women may be more inclined to consider screening if they could do it themselves in the privacy of their own homes. The La Rosee PadX sanitary pad offers this option. It has a chip that can detect 24 HPV variants and could collect cervical cells. Dr Choi Pui-wah, who underwent postdoctoral training at Harvard and earned a PhD in biochemistry from the Chinese University of Hong Kong (CUHK), is founder of the femtech start-up WomenX Biotech, which developed the pad. A woman wears the pad during her period long enough for it to collect sufficient blood, then seals it inside a special bag and posts the bag to a specified medical lab, Choi says. As a specialist in obstetrical and gynaecological research, Choi understands the imperative of Pap smears – but admits to having skipped them in her annual check-ups because of the “psychological stress”. Only about 30 per cent of women in Hong Kong undergo regular Pap smear screening, she says, and even fewer do in Southeast Asia. Some PadX users say having their first Pap smear put them off having any more. “From our clinical study data, the percentage of women in Hong Kong who have had at least one Pap smear is around 48 per cent, while the regular Pap smear rate is 33 per cent,” she says, adding: “24 per cent of women cite embarrassment and discomfort as a reason for rejecting a Pap smear test.” There can be other reasons. A friend of Choi’s, who helped inspire PadX’s development, was sexually assaulted and did not want to undergo an invasive gynaecological procedure. The friend was obliged to submit an HPV report to a legal entity, though, and was upset to learn there was no non-invasive method. Choi was curious: why were there urine and blood tests for sexually transmitted diseases, but none for HPV? So began the idea for PadX, which came to fruition last year. To test it, 119 women joined a study in 2024. They were asked to use the PadX and have a Pap smear at a designated clinic to reveal their HPV status. Both sets of samples were sent to a medical lab for analysis. PadX had a 99.2 per cent accuracy rate. PadX is the first such test developed in Asia, and now available online, at Manning’s pharmacies and other clinics and shops in Hong Kong. Other tests designed for use at home include the Papcup, developed by Imperial College London scientists and engineers in the UK, and the Teal Health Cervical Cancer Screening device now under US Food and Drug Administration review. Recently, a urine test that can detect 14 types of cancer-causing high-risk HPV was developed in Hong Kong, for use by men and women. The Indicaid test is also available at Manning’s, Watsons and other Hong Kong shops. Like what you read? Follow SCMP Lifestyle on Facebook, X and Instagram. You can also sign up for our eNewsletter here.

How cervical cancer home-test kits can end Pap smear pain and save more women’s lives

Pap smears save many lives, but many women avoid the uncomfortable and intrusive procedure. New self-test kits could change this