Jeff Andrews, MD, FRCSC is Medical and Scientific Affairs Vice President for BD Life Sciences. A board-certified obstetrician and gynecologist, Dr. Andrews has provided care in community settings in both metropolitan Toronto and Ontario, Canada and Washington, DC. He has also provided care in academic settings as an Associate Professor at Duke University Medical Center and at Vanderbilt University Medical Center. At BD, Dr. Andrews has focused on molecular diagnostics and the prevention of cervical cancer through early detection of cancer precursors, and on novel approaches to the diagnosis of infectious diseases in women. In 2020–2021, Dr. Andrews worked with the BD teams delivering SARS-CoV-2 diagnostics to meet the needs for molecular testing and for rapid point-of-care testing.
MLO: What did BD’s survey find as the most prominent barriers to access in cervical cancer screening?
Dr. Andrews: The number one reason why women aren't being screened is lack of awareness and finding the guidelines confusing. In addition, not having access to a doctor who does the screening and was more prominent in the U.S. than in the other countries. Lastly, many women reported discomfort or embarrassment and undergoing the exam. Because of that, we went on to ask some questions about self-collection. If going to the doctor to have cervical cancer screening is uncomfortable or embarrassing, would you be interested and more comfortable doing a self-collection? The majority of women in all three countries responded affirmatively. So, we think that this is further motivation for everyone involved in the effort to bring self-collection to the U.S.
Currently, if the screening test is a pap test, that generally requires an OB-GYN because of the actual procedure. But self-collection opens up the possibility that any doctor could order that test for the woman, and then she could perform it herself. So, it would greatly expand the opportunities. We also know from our previous Haris survey that there are very important disparities in the U.S. healthcare system. With respect to underserved women and cervical cancer screening and also outcomes of the disease, Black women and Hispanic women are disadvantaged, and so we were also interested in asking them about self-collection — they were also positive about that as an option.
MLO: Why is there such an alarming knowledge gap around cervical cancer screening and treatment?
Dr. Andrews: So, there's a push–pull around how people get information. So, clearly a lot of people are not necessarily seeking the information or it may be hard for them to find the answer to the question they're looking for. BD is also working with the American Cancer Society’s National Roundtable on Cervical Cancer and the White House’s Cancer Moonshot to try to generate more outward communication. Another opportunity is when people are encountering the healthcare system: either their primary care doctor or their OB-GYN have an opportunity for explanation and learning with their patients.
MLO: Does this differ among women in the United States, United Kingdom, and Sweden?
Dr. Andrews: The numbers are pretty consistent although the U.S. tends to be worse off I guess you could say. One reason was the delay in testing because they didn't have access to the clinician who could do it. U.S. women were about twice as likely to say they have delayed a gynecology visit because they didn't have an OB/GYN (27% U.S., 16% Sweden, 14% U.K.).
There was also confusion in testing guidelines or not knowing the difference between a pap test and HPV test, those percentages across countries were fairly similar. When it comes to confusion about thinking that the pap is the most accurate test, which actually isn't true, that number was highest in Sweden, lowest in the UK and the US was, was right in the middle. I thought the results being similar was interesting because self-collections are available in Sweden quite broadly and not at all in the U.S.
MLO: What can be done to address the knowledge gaps in the United States across race and ethnicity?
Dr. Andrews: Well, you’re helping raise awareness. I think knowledge of HPV is important for a couple of reasons. First of all, children in the United States should be vaccinated against it, and in the future, you and I won't have to discuss this anymore. But also, since a large number of women in the U.S. were not vaccinated when they were young, they need to be screened, and the HPV test is the preferred test for that. The BD HPV test is unique in that it has several technical features that target genes other than genotypes 16 and 18, which vaccines target. We call ours extended genotyping, which is the only one approved in the U.S. So, we're now seeing a decrease in the proportion of 16 and 18 in the cohorts that are entering screening, which is what you would expect. So, therefore, this is the time when we need to know more about the other genotypes that weren't in that original vaccine.
MLO: Will self-collection help to address the issues of access and education?
Dr. Andrews: I hope so. At the moment, about thirty percent of women in the U.S. are outside of screening guidelines, meaning they haven't been screened within the last period of years when they should have been or, or they've never been screened at all, and those women experience sixty percent of the cervical cancer that happens in the U.S.
Globally, there's an effort to figure out how to reach those women with both information and screening. Some of these barriers that account for the access problem and the disparity problem can be addressed by self-collection. And also, as I mentioned, it means you don't have to go to a specialist to get an exam and pap test collection. That's something you could do yourself at home.
In preparation for the expectation that this will be approved, BD has been talking to organizations that serve under-served women, like federally qualified health centers, because when the women come in for different reasons for care, there might not be anyone there who can do a pap test. However, anyone could prescribe a self-collection test for them. So, I believe it's probably the most important tool to reach these women, plus greater awareness.