The method is non-invasive, can be performed at home and could increase participation in cervical cancer prevention programs.
Persistent infection with certain types of human papillomavirus is the leading cause of cervical cancer, and HPV testing is an essential component of screening.
However, some women do not participate in screening programs, for various reasons such as fear of pain, lack of privacy, stigma or lack of information. In this context, specialists are looking for alternative screening methods that are more easily accepted.
A group of researchers in China evaluated the diagnostic accuracy of HPV testing of menstrual blood compared with cervical samples collected by medical personnel for detecting high-grade cervical lesions, defined as CIN2+ or CIN3+, which usually require treatment.
How the study was conducted
The analysis included 3,068 women aged 20 to 54 years who had a regular menstrual cycle recruited between September 2021 and January 2025 from four urban communities and three rural communities in Hubei Province, China. Each participant provided three samples: a menstrual blood sample collected using a minipad – a sterile cotton strip attached to the absorbent area of a regular absorbent pad – a cervical sample collected by the physician for comparison and an additional cervical sample for laboratory processing.
The participants also had access to a WeChat mobile application, called Early Test, through which they could consult the test results and receive recommendations from health professionals.
The main evaluation criteria were the sensitivity and specificity of the tests. A test’s sensitivity shows its ability to identify people with the disease, and specificity refers to the ability to correctly exclude people without the disease.
The conclusions of the study
HPV testing of menstrual blood samples collected with the minipad had a sensitivity of 94.7% for detecting CIN2+ lesions, comparable to that of physician-collected cervical samples, which was 92.1%.
Specificity was slightly lower for menstrual than cervical blood samples, 89.1% compared to 90.0%.
The negative predictive value, i.e. the probability that a person with a negative test does not have the disease, was identical for both methods, at 99.9%.
Likewise, there were no significant differences either in the positive predictive value, 9.9% for minipad and 10.4% for cervical samples, nor in the colposcopy referral rate, which was similar between the two methods.
The authors point out that the integration of testing with the mobile application simplified the communication of results and patient counseling, which could facilitate the large-scale implementation of this form of screening.
The study has an observational concept, and the authors mention the existence of some limitations that must be taken into account. However, the researchers conclude that the data obtained support the use of the analysis of menstrual blood collected with the minipad as a standard and non-invasive alternative for cervical cancer screening.
According to the authors, the results of this large population-based study support the inclusion of HPV testing in menstrual blood in national cervical cancer screening guidelines.
The study was published on Wednesday in the journal The BMJ.
