To the Editor.—The study by Li et al1 provided solid scientific foundation for the choice of vulvar specimens in high-risk human papillomavirus (HPV) testing as a means for early detection of cervical cancers. Their Figure 2 highlighted an issue that may need to be addressed—the preanalytic phase. There are some cases where HPV is detected in only the cervical (blue bars) but not the vulvar specimens. A possible explanation is that patients had urinated or cleaned the introitus before presenting themselves for a vulval swab at the clinic. Other researchers have used sanitary napkins to enable self-collection of cervicovaginal discharge2 or menstrual blood3 and validated these specimens for HPV detection. These studies also avoided the confounding preanalytical variable of losing diagnostic material before clinician-directed sampling. The attractiveness of specimens such as vulval swab/cervicovaginal discharge is obvious: self-collection and mail-in for better provision of care to remote/underserved areas and for patients who are not very motivated to go to the clinic. Now the last remaining roadblocks are validating self-collected vulvar samples for HPV testing and how to roll out the service, advertise, get reimbursed (a mobile platform is a possibility), and report the findings in a secure fashion that attracts motivated as well as less-motivated women to have cervical cancer screening.
Competing Interests
The author has no relevant financial interest in the products or companies described in this article.