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Publication Date
4-29-2026
Keywords
oregon, milwaukie, oregon gme, milwaukie gme, milwaukie oaa
Disciplines
Family Medicine | Medical Education | Obstetrics and Gynecology | Oncology
Abstract
Background: Cervical cancer screening is a cornerstone of preventative healthcare and cancer screening in primary care. Based on data from the CDC, in the US alone, the rate of new cervical cancers each year is ~13,000, accounts for ~4,000 deaths annually, and disproportionally effects people of color and people of low SES (CDC, 2025). In our clinic (PMG Milwaukie), the rate of cervical cancer screening has remained around 70% for years, which is below the national average of ~75% (Healthy People, 2021). Primary HPV screening with self-collected swabs has been used successfully for years outside of the US, improving screening rates, specifically for under-screened groups. In 2024, the FDA approved a self-collected swab for use in the US. In February 2025, the ASCCP (American Society for Colposcopy and Cervical Pathology) updated guidelines to recommend primary HPV screening (as opposed to co-testing or cytology alone), with self-collected samples as an acceptable option for some patients ages 25-65. This is a seismic shift in cervical cancer screening, allowing for less invasive screening options to a multitude of patients for which exam was a barrier to receiving care. Objectives: The aim of this quality improvement project was to incorporate self collected primary HPV screening as an option for our patients to improve cervical cancer screening rates in our clinic. The Healthy People Initiative has set a goal benchmark for cervical cancer screening of 79.2% by 2030. Methods: Given the understanding that self-collected primary HPV screening is a large change from prior guidelines and is a relatively new concept in the US for cervical cancer screening, we first developed a workflow focused on appropriate patient selection and counseling as well as follow up for positive screening tests. As provider education and adoption is essential to this process, we addressed this through didactic sessions, clinical poster materials, and at the bedside through a PARQ dotphrase to aid providers in counseling and appropriate patient selection. As a precaution to ensure appropriate patient selection during the adoption of this new screening process, we embedded a hard stop acknowledgement to ensure providers reviewed eligibility criteria. The final aspect of our workflow is quality assurance. Acknowledging that a positive or indeterminant result is incomplete screening, we created a report to track results and ensure appropriate follow-up. The next process that we are focusing on is adoption of contemporaneous cervical cancer screening for overdue and/or under-screened patients developing strategies to identify and counsel patients due for cervical cancer screening outside of wellness exams. To prompt patients to request screening outside preventative care visits, those identified during the schedule scrub are given patient education handouts highlighting this recent change in screening options during the rooming process. Additionally, we focused on enhancing medical assistant to provider handoffs through an MA rooming dotphrase, whiteboard magnets, and chart scrubbing. Results: From 10/2025 - 2/2026, we screened a total of 39 patients using self-collected Primary HPV swabs. Of these, there were a total of 4 positive HPV results of which ¾ of those had appropriate follow up testing. Of the 39 completed tests, only one was identified as invalid by the lab and not able to be run. Based on the generated SlicerDicer reports in Epic, we did not see any significant change in the overall cervical cancer screening rates in our clinic after the introduction of self-collected primary HPV swabs, after 4 months of adoption Discussion: The introduction of primary HPV screening is a relatively new idea in the US, and the option for patient-collected swabs is even more so. Most patients in our clinic ages 25-65 are being screened using co-testing or cytology with reflex as recommended by the USPTF. While the American Cancer Society recommended a change to primary HPV screening in 2020, it remains only an option by the USPTF. The addition of a patient collected sample will provide the catalyst for shifting to primary HPV screening, as evidenced by the recent ASCCP recommendations and reflected in the USPSTF draft recommendations. For patients who qualify for self-collected testing, this offers a new opportunity to avoid more invasive pelvic exams. Through the duration of this project, we were able to screen 39 patients using self-collected samples with only one invalid test and one patient lost to follow up after a positive result. With appropriate workflows and understanding of inclusion and exclusion criteria, this can serve as a great screening tool for patients who are under screened and those with difficulty with pelvic exams. While we have yet to show any improvement in the overall screening rates in our clinic after 4 months following this change, it has been shown on large scales that offering self-collected cervical cancer screening options significantly increase screening rates (Sultana et. Al., 2026). The recent changes in the guidelines represent a drastic change from previous recommendations, and change takes time. Incorporating cervical cancer screening into the primary care workflow outside of a traditional wellness exam introduces its own barriers, including additional time constraints. We also recognize that outreach is an important part of preventative care and will likely play a role in ongoing efforts to improve cervical cancer screening at our clinic. Moving forward, our goal is to continue to optimize the workflow to incorporate cervical cancer screening into non-wellness visits by improving provider recognition of patients due for screening as well as introducing an outreach program aimed at under-screened patients. From a system standpoint, creating consensus around screening recommendations, especially in the setting of the effective dissolution of the USPSTF is essential. As we move forward, large scale changes require institutional support. Creating an integrated decision aid to reflect these changes may serve to enhance provider adoption. Creating a system to follow abnormal results, as recently emphasized in October 2025 by the ASCCP, is an essential step in any screening process.
Area of Special Interest
Women & Children
Area of Special Interest
Cancer
Specialty/Research Institute
Oncology
Specialty/Research Institute
Obstetrics & Gynecology
Specialty/Research Institute
Graduate Medical Education
Included in
Family Medicine Commons, Medical Education Commons, Obstetrics and Gynecology Commons, Oncology Commons
