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Menstrual blood eases HPV screening for cervical cancer

Author
Lynda Williams

medwireNews: Human papillomavirus (HPV) testing of self-collected menstrual blood is as effective as conventional cervical HPV screening for the detection of grade 2 or higher cervical intraepithelial neoplasia (CIN2+), Chinese researchers report in The BMJ.

They suggest that collecting minipads of menstrual blood “could be a robust alternative or replacement to clinician based testing, offering equivalent detection of high grade cervical lesions with screening efficiencies suitable for implementation at a population level.”

The study included 3068 women aged 20–54 years with a regular menstrual cycle from four urban and three rural communities in Hubei Provence. Each woman used a mini cotton pad over a standard sanitary pad to collect menstrual blood for sending to a laboratory. In addition, each participant had a standard cytology brush cervical specimen collected by a clinician that was assessed for HPV and cell abnormalities.

Women who tested positive for HPV or had atypical squamous cells of undetermined significance or worse were referred for colposcopy and biopsy where necessary, explain Zheng Hu (Women and Children’s Hospital Affiliated with Zhongnan Hospital of Wuhan University, Hubei) and co-authors.

Overall, 11.0% of women tested positive for HPV in their clinician-collected sample and 13.3% were referred for colposcopy, of whom 52 were diagnosed with CIN1, 24 with CIN2, and 13 with CIN3, while one woman was diagnosed with invasive cervical cancer.

The investigators report that minipad HPV testing detected women with CIN2+ on colposcopy with comparable sensitivity to standard clinician-collected sample HPV testing (94.7 vs 92.1%), and both methods had higher sensitivity, albeit not significantly, than cytology (78.9%).

However, minipad testing had a significantly lower specificity than clinician-collected HPV testing for detecting women with CIN2+ (89.1 vs 90.0%), and both techniques had a significantly lower specificity than cytology (96.2%). The minipad and clinician-collected tests each had a negative predictive value of 99.9%, and a similar positive predictive value (9.9 vs 10.4%).

Screening efficiency, defined as the number of colposcopies required to diagnose one case of CIN2+, was also comparable between the minipad and clinician-collected samples, with an average of 10.1 and 9.6 referrals, respectively, the authors report.

A similar pattern was found for the detection of women with CIN3+, with the minipad test showing comparable sensitivity to the clinician-collected HPV test and cytology (92.9 vs 85.7 and 85.7%, respectively), a significantly lower specificity than the clinician-collected HPV test and cytology (88.5 vs 89.4 and 95.6%), and comparable positive and negative predictive values between the minipad and clinician-collected HPV tests. Both techniques had an efficiency of 28.1 colposcopies per diagnosis.

Overall, the minipad HPV test met the noninferior consensus criteria for HPV detection compared with clinician sampling, defined as relative sensitivity of at least 0.90 and specificity of 0.98 or above, Hu et al summarize.

The researchers note that self-sampling methods offer a raft of benefits over clinician collection, including privacy, comfort, convenience, and cost-effectiveness. In addition, they highlight that the study participants received their test results promptly using a mobile app that also facilitated secure messaging with healthcare providers, and counselling and education on HPV and cervical health.

This “streamlined” approach to cervical cancer testing could help “transform screening from passive surveillance to active health management,” they write, as well as “enhancing the feasibility of implementing large scale screening.”

Hu and team therefore conclude: “The findings of this study support the integration of menstrual blood based HPV testing into national cervical cancer screening guidelines.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2026 Springer Healthcare Ltd, part of Springer Nature

BMJ 2026; 392: e084831

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