Cervical cancer is almost entirely preventable with appropriate screening and management of abnormal results, yet in the US, over 14,000 individuals were diagnosed with cervical cancer in 2023, and over 4,000 died. Black, Hispanic, and low-income individuals have higher cervical cancer incidence and mortality. Over 20% of those diagnosed with cervical cancer did not receive appropriate diagnosis and treatment after an abnormal result. The FDA approved HPV self-collection, a new form of screening, in May 2024. Self-collection will expand access to screening, but increases by nearly twofold the number of patients requiring immediate follow-up after an abnormal result. Fear of cancer, poor communication, and difficulty scheduling follow-up appointments were key barriers.
In this project we will adapt this technology to produce English and Spanish smartphone ECAs for follow-up of abnormal cervical cancer screening results (ECA-CCSA). The ECA will provide follow-up recommendations and motivational interviewing to patients with abnormal screening test results and will facilitate communication with clinic staff. Follow-up promotion over time can lead to completion of needed testing among those with barriers, and the ECA can conduct repeated conversations with patients both prior to and following clinic visits. We will evaluate ECA-CCSA in a randomized controlled trial for patients aged 21 and older with abnormal screening test results to evaluate ECA-CCSA, comparing usual care (UC) versus usual care plus the ECA (UC + ECA-CCSA). The research team is nationally recognized as leaders in cervical cancer prevention, health literacy, and innovative technologies to improve health. This study will advance our research on the development of easy-to-use technologies to empower patients. This scalable approach has significant potential to increase follow-up after an abnormal screening test result, which is timely as clinical settings are currently adopting HPV self-collection technologies. If successful, our team will promote the ECA-CCSA through national networks for broad implementation and work to adapt ECA-CCSA to other languages and settings.
This work is supported by the National Cancer Institute, and is a collaboration with Rebecca Perkins and Michael Paasche-Orlow (Tufts Medical Center).