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A program evaluation published in NEJM Catalyst Innovations in Care Delivery describes how an integrated health system in Washington State expanded cervical cancer screening by letting patients collect their own samples. Led by Beverly B. Green and colleagues, the program offered human papillomavirus (HPV) self-collection both by mail and during clinic visits to average-risk individuals with a cervix aged 30 to 64 who were due or overdue for screening. Because nearly all cervical cancers are traced to high-risk HPV, which DNA testing detects accurately from a vaginal sample, self-collection opens a route to reach members who do not come in for a pelvic examination.
The results matter to any plan chasing screening quality measures. Comparing a prelaunch window with a six-month postlaunch window, screening completion rose by an unadjusted 2.2 percentage points, a statistically significant gain achieved even though only 12.6% of the roughly 47,000 eligible members were mailed a kit and only a quarter of those were returned. The mix of care also shifted. Before the program, every screen was clinician-collected during a pelvic examination; after launch, 37.4% were patient-self-collected. By the end of 2025, the system had mailed 60,529 kits, with 22% completed, plus another 12,014 self-collect tests done at clinic visits.
Clinicians generally welcomed the change. Some reported that less time spent on pelvic examinations freed them to address other patient needs, and they described patients finding the option acceptable or preferable. The evaluation also surfaced friction worth planning for. Clinicians and some patients raised questions about screening quality, and clinicians showed knowledge gaps about the accuracy of both primary HPV testing and patient-collected samples. Success depended on clear documentation, quality assurance to identify eligible members, and standardized workflows for mailing and in-clinic distribution.
For managed care and population health teams, the report serves as a workable template for improving a stubborn screening metric while easing primary care capacity constraints and extending reach to underscreened populations. The authors conclude that HPV self-collection offers a way to screen more people efficiently and potentially widen access to primary care.
