Cost-Saving and High Impact Primary HPV Testing
Primary HPV testing could cut costs and improve cervical cancer prevention in underserved communities.
A shift to primary HPV testing could save thousands of dollars in cervical cancer screening costs while maintaining high detection rates of precancerous lesions, also making it a powerful strategy for improving health equity in underserved populations.
That encouraging news was revealed during the presentation of the abstract, “Primary HPV testing: A cost-saving, equitable, and high-impact strategy for cervical cancer screening in underserved populations.” The research followed patients seen at the Houston PAP Project, a no-cost cervical cancer screening and dysplasia treatment clinic led by Abigail Zamorano, MD, MPHS, an assistant professor of gynecologic oncology at the University of Texas MD Anderson Cancer Center in Houston. The PAP Project serves a large Hispanic urban population, primarily Spanish-speaking and uninsured. The PAP Project population has a much higher abnormal screening rate (14%) compared to studies of similar populations.
“Our goal was to evaluate missed high-grade cervical dysplasia and the cost implications of implementing primary HPV testing in a high-risk underserved population,” said the study’s lead investigator, Julie Sammouri, MD, a third-year resident in obstetrics and gynecology, also at the University of Texas McGovern MD Anderson Cancer Center. “The analysis supports our initial hypothesis: Primary HPV testing reduced screening costs while maintaining the ability to detect clinically significant disease and importantly not missing any high-grade precancer in this high-risk population.”
According to Dr. Sammouri, the study modeled the financial and clinical impact of replacing the traditional co-testing method — cytology plus HPV — with primary HPV testing followed by reflex cytology only for HPV‑positive samples. Using 2025 Medicare reimbursement rates, the team found that a primary HPV testing strategy would have saved nearly $19,000 over a 34‑month period, while missing zero cases of high‑grade precancers (CIN2+).
“For underserved populations who face barriers to health care access including screening and follow-up, primary HPV testing may help identify individuals at highest risk while avoiding unnecessary procedures (e.g. colposcopy, shorter interval screening) for patients who are HPV-negative,” Dr. Sammouri said. “For the gynecologic oncology community, these findings reinforce growing evidence that primary HPV testing is both clinically effective and economically efficient, even in high-risk populations and resource-limited settings.”
Dr. Sammouri emphasized that HPV testing can:
- Identify individuals truly at highest risk
- Reduce unnecessary procedures in patients who are HPV‑negative
- Streamline care pathways and help overwhelmed health systems allocate resources effectively including grant-funded clinics and initiatives
According to Dr. Sammouri, professional organizations including SGO, the American Society for Colposcopy and Cervical Pathology (ASCCP), and the American College of Obstetricians and Gynecologists (ACOG) already support primary HPV testing as a validated screening option. The findings further align with a robust body of research showing its superior performance, she said.
The team also highlighted HPV self‑sampling as a promising next step — an approach supported by multiple studies showing comparable accuracy to clinician-collected samples, Dr. Sammouri said. For example, she said, self‑sampling could enable more community‑based screening efforts, especially for groups with limited health care access.
“Integrating self-sampling with community-based screening is an important step toward closing screening gaps,” she said.
By adopting this strategy, health systems could reduce unnecessary procedures, streamline workflows, and reach patients who have historically been left behind, Dr. Sammouri said. The team also emphasized that as screening technologies evolve, ensuring equitable implementation remains a moral and public health imperative.
Dr. Sammouri said her team’s analysis reflected the dedication of the Houston PAP Project and its patients who trusted the program and its volunteers with their care.
“Despite being one of the most preventable cancers, cervical cancer continues to disproportionately affect underserved populations due to barriers in screening uptake and follow-up care,” she said. “As we continue to improve screening technologies, it is critical that these advances translate into equitable implementation so that the patients at highest risk benefit.”
View abstract presentation slides and session recordings on the event platform. Recordings will be available within 24 hours and accessible for 60 days.
