Dr. Chapa (2:37)

Bye. Okay, so for whatever reason, the whole idea of a dad going to get pads and tampons for their daughter, maybe even for their wife. I've done both. Let me just tell you, out of full transparency and it always feels weird. It just does. I don't know why. Now I'm an ob gyn. I just, I, I don't like to do it. So I am very thankful that Adam Sandler apparently has a lot of difficulty buying pads or tampons for his daughter as well. That does loosely, very loosely relate to what we're talking about here. Because outside of collecting menstrual blood, menstrual products, whether that's a tampon or a pad, which is what we're going to discuss in this episode, or maybe even a diva cup. And the primary function of course is to prevent spills or accidents, which is a social issue, and to collect blood in a contained, safe and health conscious way. I get that. But what if I told you that that menstrual blood collection device could also be used for HPV detection? Now I love this because I love the ingenuity, I love the thinking outside the box. But is this really going to be a thing? Is this really going to be a thing? I don't know. I mean we've already seen a major shift of course in HPV cervical cancer screening. I mean we've basically left cytology. Even though there's nothing wrong with that. If you're doing thin prep or whatever your type of cytology is, liquid based cytology, that's phenomenal. But there definitely is a. The needle has turned, the ship has turned towards primary HPV screening. Then we had the shift towards FDA allowance for HPV self collection. In other words, patient can do their own self collection of a vaginal sample in a clinical setting and even HPV self collection at home. Remember that the FDA has cleared the teal wand by Teal Health, not a sponsor for at home use. I mean we are mind blowing here. We are just totally thinking of different ways to check for HPV status as a way to help identify cervical cancer risk patients. And I love that we should be doing that, should be thinking outside the box. Well, just at the start of February 2026, in the journal BMJ, that's British Medical Journal, there is yet again somebody else who's thinking outside the box because they used pads, a special pad with a little liner in it that collects menstrual blood that would be sent off to a lab to check for HPV and they compared it to traditional clinician collected samples. All going to talk about this did this work? Short answer is, yeah, it did. And you know why he can say that? Because it wasn't just this paper that has found this and said this. Because nothing is new under the sun. Remember, there's plenty of data that. That has investigated the use of menstrual blood to detect hpv. Because, yes, we now know that HPV is shed in the menstrual blood. However. However, guys, there's a lot of limitations here, and we are not yet ready for prime time. In other words, everyday usage as a screening tool. Plus, it's kind of weird. Hey, do I have hpv? I brought you my pad. That's not how it's gonna work. Has to be a special kind of reagent or collection strip on the pad or on the tampon, both of which have been looked at in past data. One of the more recent studies before this one came out was one in the Green Journal that came out In August of 20, the title of which was Screening for High Risk Human Papillomavirus using Passive Self Collected Menstrual Blood. So the idea of using menstrual blood to check for hpv, not new, but I love how this made the headlines, and it should, because it's ingenious, it's innovative. But the headlines in the first week of February 2026 were like, oh, new researchers have found that HPV is in menstrual blood. No, duh. We've known that for about five to six years at least. And I'm not minimizing the work of these researchers out of China. Okay? It's a phenomenal, very well done study, which we're going to get into. The short question is this. If you want to check for hpv, is it possible to use menstrual blood? Well, the short answer is yeah, but there's a lot of limitations. All right, I think I've set it up enough. We will be right back. This is Dr. Chapa's obgyn clinical pearls no spin podcast. So, podcast family here is the question, is this innovation for medical and scientific progress, or is it innovation for innovation's sake? And I don't know, it's a rhetorical question. I don't see this happening on a commercial level anytime soon. But it may, it may. The idea of, hey, here's my dirty pad, Go check for hpv may be a thing in the future, but as of right now, and remember right now, we are still in the early part of February 2026. It's just not a thing. Actually, the acceptance of self testing for something like cervical cancer, which has, I mean, you got to get that right, right. This is a big test, the acceptance by patients of self collected samples, according to one very recent study, because this just came out in JAMA Network open may not be that great. Patients may want somebody who knows what they're doing to collect it or at least to collect it in a standardized area at standardized setting like the clinic. Yeah, this actually just came out in a nationally representative survey sample. 20% of women. Listen to this guys. 20% of women said they would prefer at home self sampling for cervical cancer screening. That's 20. Whereas 61% said no, you know what I'm going to stick to in clinic testing so that it's a more controlled environment. And so what this actually let us know is there may not be a big market for at home HPV collection unless there's a true physical barrier like they can't get there or they're in a very rural setting or in that special patient population who perhaps has had some kind of physical sexual abuse where self collection may seem more attractive. So according to that recent study that just came out from that survey, quote. By examining sociodemographic and health behavioral factors influencing individuals preferences for self sample, our study provides valuable insights into the adoption of this new technology which has the potential to improve access to cervical cancer screening among underserved communities. So let me stop there for a minute. So that's the good part. They're like, hey, okay, we have a chance here to really change and increase access to care. But then they say, quote. But this suggests. Meaning the findings, the findings suggest that there is an overall lower level of self confidence in performing the self sampling in the absence of a healthcare provider or outside of a medical setting, end quote. Again, fascinating. And I'm not saying that this is ever, you know, going to be a thing, you know, not going to be a thing. It may be a thing. But as of right now, I think more work has to be done. And the specific study that we're going to focus on, which dealt with again, menstrual pad analysis of HPV that just came out February 2026. And again, nothing new because a similar study was done in 2022. But, but while as intriguing and as innovative as that is, there are limitations to that and we're going to discuss those limitations as we get to the end. All right. But again, just published out of JAMA Network, open this finding that 20% said yeah, I'm okay with it. And 61% said, yeah, no, I need to get this right. I at least want to be in a medical or in a clinical setting versus do it at home. All right, so there's gaps here, and that may be part of patient awareness, patient comfort level, but right now it's a small percentage who says, yeah, I'm comfortable with this. Now, if you do the math. If you do the math, 60% said they want in clinic sample. 20% said they were okay with at home. So that leaves everybody. Everybody. That leaves 20%. 60 plus 20 is 80. So what happened to the other 20? The other 20 said, yeah, I really don't care or I'm not sure. All right, so that's a big factor. That 20% were like, man, I don't know, I just had instructions, maybe I could do it. Maybe I could just go in and get it done. But doesn't change the fact that 60% actually wanted it in a clinical setting. Again, that was out of JAMA Network Open. The title was Women's Preferences for Home Based Self Sampling or Clinic Based Testing for Cervical Cancer Screening. And again, that just came out. The other issue with that, well, not the other issue. The other tie to Texas from this study is that it does have somebody from UT Health that is our sister institution through the state of Texas, just down the road down in Houston. All right, so UT Health out of Houston, along with MD Anderson. So interesting, because most people you would think would go, yeah, hey, I'll send me a pad and I'll just do it at home. Next period I get and I'll turn it in. But right now, some of that may be a lack of awareness and, or familiarity or comfort level with this kind of deal. All right, so that's that. We just wanted to throw that out there. Is this innovation for innovation's sake or innovation for medical progress? I don't know. Rhetorical. Talk amongst yourselves. Back in the green journal in 2022, a similar study using menstrual pads for HPV detection like the one we're about to focus on here found found almost the exact same thing. Very high concordance between the menstrual pad HPV and a clinician collected samples with concordance rates. Guys, here it is around 94% with a confidence interval as low as 83 or as high as 98%. Short of it is there was 100% agreement among women with high risk HPV and CIN2 lesions. It worked. That study was by Blumenthal. So again, nothing new under the sun. And there's been a variety of products that have been tested. Tampons, little strips on the pads, menstrual blood collected like an a diva cup. All of them have shown relatively high acceptability in that patient cohort. Remember, they were studies participants, so they had strict instructions with overall anywhere from 90 to 94% being able to collect a sample and then there being very high concordance rates with a collected sample from a physician. So this does hold promise. Short of it is, let me tell you what's going on in this BMJ publication from the first week of February 2026 out of China. Okay, so nothing new. The question was, can you use menstrual blood on a specific test strip collected on a pa Send it off to the lab, look for high risk h. High risk hpv and compare it to a clinician collected sample at the same time. That's pretty much it. All right. Now this spanned about a four year time interval from September 2021 to January 2025. And lo and behold, as you would guess, yes, it did work. Now this wasn't like, hey, you bring, bring me your, your Tampax pad and I'll just send that in. No, no, it's a little strip. It's not the whole pad. A little strip placed in the middle of the pad. And then the participants took that strip off, put it into a preservative vial, and then the vial went for study. Okay, let me read you directly the methods here so I don't misrepresent this quote. Participants attached a mini pad strip to the middle anterior absorbent surface of a sanitary pad. At the start of the menstrual cycle, when more than two thirds of the mini pad surface were visibly saturated with blood, Participants removed the strip, place it in the preservative solution, seal the container and return the sample to the central lab. All right, fine, we get it. So please don't mail in your complete Tampax pad or a tampon. It's a little strip that's connected to either the tampon on the pad and then that went for analysis. In brief, the study found very, very high, almost comparable detection of important HPV genotypes. Quote, testing menstrual blood collected on the sanitary mini pad could offer a reliable, non invasive alternative to clinician collected cervical samples for HPV screening, which demonstrated. Here it is, guys. Comparative. What, what? What? What was that word? Sorry. Comparable accuracy for detecting high grade cervical lesions. English is a second language. Sorry, guys. Which demonstrated comparable accuracy for detecting high grade cervical lesions. So it did work. We're talking about high 90s in terms of detections of both sensitivity and specificity. And so they're like, hey, this could be an alternative. So yes, we get it, it works. However, however, here's the question, guys. There's things that need to be figured out. Does it have to be the first day of flow? Can it be the second day of flow? Is accuracy any different if it's the last day of flow compared to the first? We don't know these things yet. How much volume is actually necessary? Are labs ready to this to check menstrual blood collection caught on a strip or on a cup and then send in as an independent sample? We don't know. So there's a lot of questions here. Nonetheless, it's very intriguing and fascinating, but here's the last clinical pearls before we start to wrap this up, this approach. All right, so let's just say it right now, this approach is not, is not. Because I don't want to misrepresent here in any US screening guidelines from either the ACS or asc, ZP or anybody else. Although some have said that self collected vaginal specimens are totally okay. So that's different. Right? So you can self collect either at home or in a clinic setting, but the use of menstrual collected blood for HPV analysis right now is not part of any guideline. Just to be clear, I don't want to misrepresent like this is a thing. It's not. It's still investigational. There's still questions that have to be answered. As we discussed, is this any different in very high risk populations? Does is this matter what age the patient is? Maybe that's a factor. What about other conditions that may affect the sample? Does it matter if the patient has a history of endometriosis? Does it matter if she has a history of a previous cervical treatment? Nobody knows these things because this has been in the general population. So while intriguing and fascinating and if somebody asks you, can you detect HPV in menstrual blood? Absolutely. Sure you can. But while you can, that doesn't mean it's necessarily ready as a standard for cervical cancer screening. Guys, this is a big test. We want to get this right, right? It's for cervical cancer screening. So while there's been a shift in cervical cancer screening throughout the last five or six years or so, moving away from cytology, moving more towards primary HPV screening, and then even looking at a molecular level like dual stain technology. And we've covered that before before, right? We've covered the dual stain, which is A specific company, Syntek, that uses molecular analysis to see if that high risk HPV even needs copo, because if the dual stain is negative, you can buy you time. Check it again in a year. So we've learned a lot. We've basically taken cytology out of the mix, although there's nothing wrong with doing liquid based cytology as a screening with either by itself between 21 and 29 years of age or as a CO test over age 30. But primary HPV screening started at age 25 and repeated every five years seems to be the way to go. Okay, so self collection, yes, definitely a thing either at home or in a clinic setting. And the guidelines are very clear right now. Right now it says in a clinician setting, self collection can be proposed. The question is, will menstrual blood be part of that? And it's not clear right now. Not clear right now. So a lot of questions still remain. But I do think it's fascinating and I love the headlines where this comes out like something brand new, like somebody discovered this. Not so much. Many, many studies prior to this one, prior to February 2026, have found HPV, the ability to detect HPV in menstrual blood. This is not the first. All right, Podcast Family. I think we've done what we're supposed to do. We have covered a new publication that talks about menstrual blood for HPV detection, and it is kind of novel, but probably not ready for primetime. This was out of bmj, British Medical Journal, Podcast Family, as always, we're thankful for you. We're so grateful for your continued support. And now that we've done all that, let's take it home.