Menstrual blood is an easy and effective way to screen for cervical cancer that matches the current standard of care, research shows.
In a large, community-based study, reported in The BMJ, menstrual blood provided a convenient and noninvasive alternative to traditional clinician sampling of cells in the cervix.
Blood collected in a “minipad” cotton strip attached to the center of a regular sanitary pad was as able to detect high-risk human papilloma virus (HPV), which is linked with the development of cervical cancer.
HPV testing using menstrual blood detected high-grade cervical lesions as well as clinician-collected cervical samples, the researchers report.
An Early Test digital platform accessed through the WeChat app was effective in processing the blood samples, sharing results, and coordinating follow-up.
“These findings support the integration of menstrual blood-based HPV testing into national cervical cancer screening guidelines,” reported Xun Tian, PhD, from the Central Hospital of Wuhan in China, and colleagues.
They maintained: “Combined with standardized minipad-based collection and the Early Test mobile app, HPV testing of minipad collected menstrual blood could resolve real world applicability and offer a practical pathway to expand access to screening.”
Persistent infection with high-risk HPV is a key factor in the development of cervical cancer, which results in nearly 350,000 deaths each year. Despite being largely preventable, more than 660,000 women are diagnosed with this cancer each year.
Screening is often performed through a Pap smear, also known as a smear test, where a clinician collects cells from the cervix to check for HPV and abnormal changes.
However, its implementation can be hampered by women’s concerns over privacy, pain, a lack of awareness, medical infrastructure, as well as religious or cultural inequities.
The researchers examined the diagnostic accuracy of menstrual blood as an alternative to clinician-collected cervical samples among 3,068 women aged between 20 and 54 years with regular menstrual cycles who lived in four urban and three rural communities in China.
Participants each provided three samples for testing. These included a minipad attached to the absorbent area of a standard sanitary pad to collect menstrual blood for HPV testing; a cervical sample collected by a clinician for HPV testing to act as a comparator test; and a further, clinician-collected cervical specimen that was used for cytology lab processing.
Result showed that the minipad had comparable sensitivity to clinician-based HPV testing for detecting cervical intraepithelial neoplasia grade 2 worse (CIN2+) at 94.7% versus 92.1%, respectively.
Minipad HPV testing showed a lower specificity than clinician testing, at 89.1% versus 90.0%. However, the negative predictive value—indicating how likely a person testing negatively actually did not have the disease—was identical, at 99.9%.
There were no significant differences between the methods in the positive predictive value—revealing the likelihood of a person who tested positively actually having the disease—with comparable results also for referral for further colposcopy testing.
“The results of this study suggest that minipad collected menstrual blood for HPV testing is an equivalent alternative or replacement to the current standard of care for cervical cancer screening, with non-inferior sensitivity and specificity for the detection of CIN2+ compared with clinician collected samples for HPV testing,” the researchers reported.
“Combined with standardized minipad based collection and the Early Test mobile app, HPV testing of minipad collected menstrual blood could resolve real world applicability and offer a practical pathway to expand access to screening.”
