Congressional briefing examines barriers to at-home cervical cancer screening

Most insurers will have to cover self-collected human papillomavirus (HPV) tests without cost sharing starting Jan. 1, 2027, under updated federal preventive guidelines. Panelists at a Sept. 17 Capitol Hill briefing asked regulators to go a step further and issue billing codes that cover two-way shipping and postage, so safety-net clinics and labs aren't left paying to mail kits out and back.

The briefing, "Expanding Access to Cervical Cancer Screening through At-Home Self-Collection," was co-sponsored by Waters Corp., which markets an at-home HPV collection kit cleared by the Food and Drug Administration in April, along with the American Society for Colposcopy and Cervical Pathology (ASCCP) and several cancer advocacy groups.

ASCCP President Christine Conageski, M.D., moderated. "Basically, at this point, a diagnosis of cervical cancer is a failure of our system," she said in her opening remarks.

Where the screening gap stands

In 2023, 14.8% of U.S. women ages 30 to 65 said they had never been screened for cervical cancer, up from 5.3% in 2005, according to an Aug. 27 research letter in JAMA Network Open.

Among women ages 21 to 29, the share climbed from 12.5% to 31.9%. Regional- and distant-stage incidence each rose more than 2% a year after 2017 in the older group.

In the PRESTIS trial, run in Houston's public safety-net system and published in JAMA Internal Medicine in June 2025, 41.1% of under-screened women who got a mailed self-collection kit and a phone reminder completed screening within six months, compared with 17.4% who got the reminder alone.

Adding a patient navigator brought participation to 46.6%. The trial's first author, Jane Montealegre, Ph.D., of the University of Texas MD Anderson Cancer Center, sat on the panel.

"If we can scale up our screening to reach 90% of the population, we can reduce that timeline to elimination by over a decade," Montealegre said, putting that at 40,000 women who would not die of a preventable cancer.

On coverage, she said, "We really need to make sure that the powerful language really plays out into powerful policy."

Navigation services for breast and cervical cancer screening were added to the women's preventive services guidelines in December 2024, and most private plans have had to cover them without cost sharing since plan years beginning in 2026.

The panel's ask goes to who pays the navigators: they are reimbursed only after an invasive cancer diagnosis, according to organizers' summary of the discussion, and paying for navigation during screening and follow-up cuts missed diagnostic appointments in half.

A positive test still lands in the office

"Our efforts to increase screening are essentially futile if they are not paired with strategies to ensure and improve the follow-up that needs to happen with an abnormal test result," said Sangini S. Sheth, M.D., of Yale School of Medicine. A positive result on a self-collected sample sends the patient back to a clinician for cytology or colposcopy, depending on the genotype.

The American College of Obstetricians and Gynecologists made the same point in January when it backed the new coverage rules, warning that expanding access without systems to connect patients to follow-up testing could delay diagnosis.

"We need to have a menu of options," said Linda Eckert, M.D., of the University of Washington School of Medicine. "Many people do want to have a Pap smear... but many people don't." She also cited the World Health Organization's economic case, saying that "for every dollar spent on screening, you get $26 back to your economy."

WHO's estimate is $3.20 returned per dollar invested in cervical cancer elimination through 2050, rising to $26 when societal benefits are counted.

Eckert put the U.S. toll at "one woman dies every two hours." The American Cancer Society projects about 13,490 new cervical cancer cases and 4,200 deaths this year.

"We've done studies that show for every 100 deaths of cancer that there are 121 maternal orphans," said Leeya F. Pinder, M.D., of the University of Cincinnati College of Medicine.

Policy watch

The SCREENS for Cancer Act would reauthorize the Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program through 2030 at $235 million a year.

The House folded it into the EARLY Act reauthorization, H.R. 4541, and passed that bill in July, sending it to the Senate. The PREVENT HPV Cancers Act, H.R. 6561, from Rep. Kathy Castor (D-Florida), Rep. Don Bacon (R-Nebraska) and Rep. Kim Schrier, M.D. (D-Washington), targets vaccination and screening infrastructure in rural and underserved areas. It sits in the House Energy and Commerce Committee.

Until the codes exist, the cost of the shipping sits with whoever mails the kit.