The Self-Screening Superpower: Taking Control of Cervical Cancer

A Public Health Crisis

Undressed, legs spread open, lying under fluorescent lights as a stranger pokes and prods at your genitals. This is the uncomfortable experience of many assigned females during their Pap test, a routine but invasive cancer screening examination of the cervix, which connects the womb to the vaginal canal. But what if you could screen cervical cancer from the comfort of your own home? Human papillomavirus (HPV) self-sampling (SS) is an innovative screening strategy to optimize early detection of cervical cancer. As the fourth most common cancer in women worldwide (Arbyn et al., 2020), 99% of cervical cancer is caused by high-risk HPV infection (World Health Organization [WHO], 2022). However, it can be cured if detected and treated early (WHO, 2022). SS kits allow people with a cervix (encompassing women, Two-Spirit, transgender and gender-diverse individuals) to use a swab to collect a vaginal sample at home and mail it to a laboratory for testing (WHO, 2022). If high-risk HPV strains are detected, the patient is connected to follow-up clinical assessments. However, a debate remains: is SS an effective solution to reduce cervical cancer or is it a far-fetched dream that can’t realistically be nationally implemented?

The Superpowers of Self-Sampling

Despite the pervasiveness of cervical cancer, 25% of women in the United States don’t undergo their recommended screening (White, 2017). Individuals from equity-seeking social locations such as 2SLGBTQI+ individuals, Black and Indigenous women, women from a low socioeconomic status, and women with disabilities are disproportionately impacted by cervical cancer, yet they are the least likely to undergo recommended screening (Charlebois & Kean, 2024). They may face obstacles such as difficulties accessing a family physician, incompatible clinic hours, lack of transportation (especially for northern, remote, isolated communities), cultural concerns about modesty, and indirect costs, such as childcare or booking time off work (Madzima et al., 2017).

However, SS is a possible solution to reach these underdiagnosed populations. Completed in the privacy of one’s home, SS has been found to have a high acceptability among under-screened demographics, who report less embarrassment, pain, anxiety, and discomfort than in Pap tests (Madzima et al., 2017). SS has increased screening uptake in underscreened populations, almost doubling participation in cervical cancer screening services (WHO, 2022). In a study of 697 women from low-income backgrounds, mailed SS kits increased uptake of cervical cancer screening when compared to usual care (help scheduling in-clinic appointments), with 78% returning their SS sample for testing (Pretsch et al., 2023).

SS can also be an empowering process. Women that have experienced intimate partner violence (IPV) and sexual trauma face a greater risk of cervical cancer as they are subjected to worse social determinants of health (such as unemployment, limited education, or a low income) yet also have lower cervical cancer screening rates due to feelings of retraumatization during in-clinic pelvic exams (Madding et al., 2024). Interviews of women with a history of IPV found they preferred SS over clinician-administered sampling due to an increased sense of autonomy, safety, and control (Madding et al., 2024).

Furthermore, SS execution is highly feasible, with positive outcomes seen in countries that have already begun to implement it. It has been shown to be more cost-effective and more sensitive at detecting HPV when compared to clinician-collected Pap test samples (Charlebois & Kean, 2024). Australia initiated universal HPV SS in 2022, with 40% of individuals overdue for screening using SS methods and leading to increased rates in remote areas and Indigenous communities (Charlebois & Kean, 2024). By increasing accessibility, convenience, and comfort in a feasible and highly validated method, SS decreases health inequities for individuals who need it the most.

The Struggles of Self-Sampling

            Despite the many benefits it offers for hard-to-reach populations, SS also presents new challenges. Mailed SS kits are not necessarily accessible to all underscreened populations, as they require a mailing address for kit delivery, a safe and private location for sample collection, and transportation to clinics if follow-up care is necessary. Additionally, many women report concerns regarding sampling accuracy, both due to lack of confidence in their own specimen self-collection abilities and lack of trust in the results (Madzima et al., 2017). If samples are inadequately collected, there might be an overreporting of negative tests (indicating no HPV when in reality HPV is present). Even if the test correctly detects the presence of HPV, there are still low rates of follow-up care participation after diagnosis (Wang & Coleman, 2023). Women in the United States report lack of healthcare coverage as a major barrier to follow-up care (Madzima et al., 2017). In Canada, only British Columbia and Prince Edward Island have implemented free SS as the primary screening strategy for cervical cancer (Canadian Partnership Against Cancer, 2024). These obstacles disproportionately impact equity-seeking communities, including Black women or women of low socioeconomic status (Wang & Coleman, 2023). So, although SS increases screening uptake, it may not actually decrease cancer incidence rates if women are unable to access follow-up treatment. SS can also create tensions within marriage, as some women face accusations of untrustworthiness and infidelity when testing for sexually transmitted HPV, leading to avoidance of screening (Madzima et al., 2017). By presenting logistical, systemic, and relationship challenges, SS may perpetuate health disparities in cervical cancer screening.

Somewhere in Between

            SS has been shown to be a highly accessible, acceptable and feasible alternative to Pap tests, with the ability to increase early detection and treatment of cervical cancer within equity-denied populations (Madzima et al., 2017). However, in order to be successfully implemented, SS interventions require more than simply mailing a kit; each stage of the process needs to be considered, from recruitment to screening to follow-up care. Instead of only relying on medical clinic recruitment sources, community outreach programs based on geographical social and material deprivation indexes can help recruit hard-to-reach, underscreened populations (Canadian Partnership Against Cancer, 2024; Pretsch et al., 2023). The dissemination of information about the benefits, efficacy, and the correct specimen collection process should be provided to women to increase confidence in and knowledge of HPV screening, harnessing culturally-relevant communication methods, both formally (public service announcements) and informally (social media and phone texts), to prompt follow-up appointment reminders and provide information on SS guidelines. Policy reforms that facilitate follow-up linkage after a positive test result should be implemented. Using a holistic, multicomponent approach that combines SS with reminder letters and personal contact with physicians to provide explanations of test results has been shown to improve follow-up adherence (Madzima et al., 2017). As well, follow-up participation can be enhanced by enlisting community health workers to encourage feelings of trust and safety, offering mobile treatment to reduce transportation barriers, and pre-booking follow-up appointments. As much of the current research is limited to cisgender women, future studies should include all individuals who have a cervix to ensure the wider generalizability of findings. Ultimately, if appropriately implemented, SS is a self-empowering game changer that can reduce cervical cancer and begin to dismantle systemic health inequities.

Maya Druss-Wong (She/Her), 4th year BSc Psychology, Queen's University. 

References

Arbyn, M., Weiderpass, E., Bruni, L., de Sanjosé, S., Saraiya, M., Ferlay, J., & Bray, F. (2020). Estimates of incidence and mortality of cervical cancer in 2018: A worldwide analysis. The Lancet Global Health, 8(2). https://doi.org/10.1016/s2214-109x(19)30482-6

Canadian Partnership Against Cancer. (2024, September 24). HPV testing. https://www.partnershipagainstcancer.ca/topics/cervical-screening-canada-2023-2024/modalities/hpv-testing/

Charlebois, S., & Kean, S. (2024). To eliminate cervical cancer in Canada, nationwide funding of self-sampling for human papillomavirus is needed. Canadian Medical Association Journal, 196(21). https://doi.org/10.1503/cmaj.240722

Madding, R. A., Currier, J. J., Yanit, K., Hedges, M., & Bruegl, A. (2024). HPV self-collection for cervical cancer screening among survivors of sexual trauma: A qualitative study. BMC Women’s Health, 24(1). https://doi.org/10.1186/s12905-024-03301-x

Madzima, T. R., Vahabi, M., & Lofters, A. (2017). Emerging role of HPV self-sampling in cervical cancer screening for hard-to-reach women: Focused literature review. Canadian Family Physician, 63(8), 597–601.

Pretsch, P. K., Spees, L. P., Brewer, N. T., Hudgens, M. G., Sanusi, B., Rohner, E., Miller, E., Jackson, S. L., Barclay, L., Carter, A., Wheeler, S. B., & Smith, J. S. (2023). Effect of HPV self-collection kits on cervical cancer screening uptake among under-screened women from low-income US backgrounds (MBMT-3): A phase 3, open-label, Randomised Controlled Trial. The Lancet Public Health, 8(6). https://doi.org/10.1016/s2468-2667(23)00076-2

Wang, R., & Coleman, J. S. (2023). The HPV self-collection paradox: Boosting cervical cancer screening, struggling with follow-up care. The Lancet Public Health, 8(6). https://doi.org/10.1016/s2468-2667(23)00094-4

World Health Organization. (2022). Self-care interventions: Human papillomavirus (‎HPV)‎ self-sampling as part of cervical cancer screening and treatment, 2022 update. https://www.who.int/publications/i/item/WHO-SRH-23.1

The Right to Bleed: Period Poverty in Canada and the United States

How often should menstrual pads be changed? Every: (A) 3-4 hours (B) 4-5 hours (C) 5-6 hours (D) 6-7 hours

I was shocked to learn, while researching for this blog, that the correct answer is (A) 3-4 hours, and that the ideal changing window is even shorter—2-3 hours—for optimal hygiene (Sun et al., 2024). While serious health risks like urogenital infections are more commonly associated with menstrual product use beyond 6 hours, bacterial growth begins much earlier, and regular changes help minimize this risk (Billon et al., 2020; Singh et al., 2023). However, when I check my bathroom cabinet, the packaging on my Always brand pads claims “8 hours maximum,” a notable difference.

Period poverty is a general term for having inadequate access to menstrual products, menstrual health education, and waste and sanitation facilities like toilets and sinks (Jaafar et al., 2023). Experiencing period poverty can worsen the social, psychological, and physical well-being of menstruators. For example, it can lead to missed school and work, shame and distress, and improper menstrual health management leading to infections like toxic shock syndrome (Barrington et al., 2021; Selina et al., 2019). While this topic has been well researched in low- and middle-income countries, the United States (U.S.) and Canada lag far behind (Lee et al., 2024; Patel et al., 2022). This gap in research comes, in part, from the misconception that there's nothing to study—that in high-income countries, people couldn’t possibly lack access to products, information, or sanitation. This is simply not the case. In fact, Canada has been even slower than the U.S. to collect national data on period poverty. Most of what we know comes from nonprofit organizations, with few academic calls to action until recently (Lee et al., 2024).

Who Really Pays? Economic Disparities and Menstrual Products

In the United States, around 40 million menstruators live in poverty or near poverty (Sacca et al., 2023). According to a 2023 survey conducted by Environics Research for Women and Gender Equality Canada (2023), 17% of menstruators have experienced period poverty in Canada, and if household income is lower than $40,000 a year, this number rises to 25%. Because this leads to the difficult decision between proper menstrual products or food and other necessities, sometimes menstruators resort to using homemade or unsafe products. For example, individuals from both Canada and the U.S. have reported using children’s diapers, strips of cloth, toilet paper, tissues, or washed single-use menstrual products for reuse (Lukindo et al., 2022; Sebert Kuhlmann et al., 2022). These substitutions are not made for menstrual blood and/or are unsafe, putting them at risk of accidental leakage at best and infection at worst. Furthermore, those working low-income jobs may have fewer opportunities to change their products due to long and inflexible work hours, which is uncomfortable and even dangerous, especially when combined with homemade or inadequate products (Johnson & Fujishiro, 2023). Lastly, in some areas, the financial burden of period products is worsened by taxation, sometimes referred to as the “tampon tax.” Canada eliminated federal tax on menstrual products in 2015, but most U.S. states retain the tax (Canada Revenue Agency, 2015; Crays, 2020). 

Knowledge is Power: Sexual and Menstrual Health Education

Sexual health education (SHE), which includes menstrual health and management education, is controlled at the provincial/territorial level within Canada. Therefore, there is great variability in the content, time allocation, and recency of the material across provinces and territories (Robinson et al., 2019). 

Similarly, evidence-based menstrual health education is not federally mandated in any U.S. state or territory, and only four states have legislation making it necessary (Jones & Baldwin, 2025). In fact, states like Arkansas and Florida have legislation which prevents SHE before grades five and six respectively (SIECUS, 2021, 2024). This is a cause for concern, as children can begin menstruating as early as ages 8 and 9 (grades 3-4), and students often report experiencing distress and fear when menstruation begins before their school covers puberty education (Schmitt et al., 2022a). The remaining states do not teach menstrual health education early enough that children can anticipate changes to their bodies and be prepared for them (Jones & Baldwin, 2025).

While SHE is controlled by the state or provincial government, the inconsistencies and knowledge gaps create ripples across both Canada and the United States. Unfortunately, the national variability does not allow for high-quality assessment of these gaps within peer-reviewed research. Therefore, much of what we know is from nonprofit organizations. In a nonprofit Canadian survey conducted by Plan International (2023), 65% of respondents said they did not receive any type of menstrual health education including anatomy, hygiene, and menstrual symptoms. Moreover, while provincial control is similar to the U.S., Canadian provinces rarely update or monitor the effectiveness of these programs. Some provinces, like Manitoba and the Atlantic provinces, have almost no current public data on menstrual education in schools, leaving wide gaps in knowledge (Robinson et al., 2019).

These education gaps leave many children and communities unprepared, uninformed, and unsupported, directly contributing to period poverty. Indeed, individuals may lack the necessary knowledge to safely manage menstruation or understand whether their menstrual symptoms are healthy. For example, many suffer from heavy or abnormal uterine bleeding, which can cause lack of focus, missed school, and anemia (Matteson et al., 2012; Sawyer et al., 2024). A lack of knowledge may prevent individuals experiencing these symptoms from identifying this bleeding as problematic in the first place, hindering them from accessing health care and improving their quality of life. However, the normalization of severe menstrual pain and heavy bleeding within the healthcare system, exacerbated by gender bias, often leads to the dismissal of these symptoms, creating yet another barrier to equitable menstrual healthcare (Wiggleton-Little, 2024). Additionally, many schools strictly police bathroom breaks, limiting necessary access to waste management and sanitation facilities—both of which are crucial for menstrual health. (Schmitt et al., 2022b; Secor-Turner et al., 2020). Moreover, the burden of this educational inequity falls hardest on low-income, gender-diverse students, and those who live in rural areas, who face compounded barriers to menstrual health knowledge and care (Casola et al., 2023; Secor-Turner et al., 2020; Townsend et al., 2023). Addressing these gaps requires the implementation of national, evidence-based, inclusive menstrual health education standards that reach children before the onset of puberty.

A Potential Blind Spot: The Safety of Menstrual Products 

Are menstrual products safe? The answer: it depends on who you ask. Influencers on social media have raised alarm about tampons containing bleaches and metals, potentially harming the users’ health (Butcher, 2024; Jung, 2025). What does science say? A lot of the high-quality research on the safety of tampons conclude that tampons are safe (Hochwalt et al., 2010, 2023); safe, within this context, means a permissible amount of vaginal irritation, physical discomfort, and infection risk. These studies, though, focus on the short-term and are characterized by conflicts of interest (e.g., the research received funding from the tampon company). In contrast, independent studies raise concerns with the long-term use of tampons. For example, pesticides, industrial chemicals, and toxic metals have been found in menstrual products (Shearston et al., 2024; Upson et al., 2022). Concerningly, no tests have been done on how the vagina reacts to these chemicals or their long-term effects. Yet, there is also little to no evidence suggesting tampons pose a chronic health risk.

Period poverty is often discussed in terms of access to products, which is also the main focus of this blog. But unbiased science confirming product safety and ingredient disclosure is also crucial. Overlooking these aspects reflects broader systemic gaps in how menstrual health is prioritized, and more solid research—and clear safety regulations—are needed.

Gatekeeping the Right to Bleed: Transgender and Non-binary Individuals

Within our sociocultural climate, menstruation is viewed as a gendered process equated with ‘womanhood.’ Evidence is easy to find—for example, the language and imagery on sanitary pad packaging are almost exclusively characterized by floral patterns, pastel pink colours, and messaging targeted at cisgender women. However, people of various gender identities menstruate, such as trans men and non-binary individuals. Secondly, not all who identify as a woman menstruate, such as pregnant women, trans women, postmenopausal women, and those with amenorrhea. Menstruation is not a gender identity; it is a biological process. 

Associating periods strictly with womanhood comes with exclusionary consequences directly related to menstrual equity. For example, trans men may be excluded from conversations and the narrative of period poverty. Indeed, most statistics only include women who menstruate, not menstruators, rendering our knowledge inaccurate. Relatedly, most menstrual education is framed towards cisgender girls and women, which may alienate people of diverse gender identities who menstruate. Moreover, almost all pads and panty liners are designed to fit traditionally feminine underwear, making them difficult for those who wear boxers or briefs to use. Furthermore, most men’s bathroom stalls do not have sanitary napkin receptacles or trash cans, making disposal stressful. This is compounded by the stress of quietly opening a sanitary pad wrapping to avoid outing oneself or being put in a dangerous situation. Indeed, a Connecticut-based study found that over 60% of a sample of trans men felt unsafe using a “men’s bathroom” during their periods (Chrisler et al., 2016).

We Can't Wait and Bleed: Period Equity for All

Period poverty is not just about having pads or tampons—it's about the human right to manage menstruation with dignity, safety, and choice. Whether in Canada or the United States, the failure to provide safe, affordable products, transparent information, and quality inclusive education continues to harm those who menstruate—especially those already marginalized by income, geography, or gender identity. These are not isolated problems. They are connected, systemic, and solvable. We must move beyond nonprofit-driven period product giveaways and demand menstrual justice: federally funded research, ingredient disclosure, inclusive and early menstrual education, and policy frameworks that see menstruation not as a private burden, but as a public health, equity, and rights issue. The right to bleed safely and without shame belongs to everyone who menstruates.

Ruxandra-Ioana Adam, 3rd year BSc Psychology, Queen's University

Note: AI was used for certain minor elements of this blog (e.g., references, grammar). 

References

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Billon, A., Gustin, M.-P., Tristan, A., Bénet, T., Berthiller, J., Gustave, C. A., Vanhems, P., & Lina, G. (2020). Association of characteristics of tampon use with menstrual toxic shock syndrome in France. EClinicalMedicine, 21, 100308. https://doi.org/10.1016/j.eclinm.2020.100308

Butcher, A. [@abibxbz]. (2024, July 10). Just going to free flow at this point 😭. [Video]. TikTok. https://www.tiktok.com/@abibxbz/video/7390088029970517281?q=tampons%20cause%20cancer&t=1747441060919

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