Health Rounds: Swabs as good as unpleasant speculum exam for detecting cancer-causing HPV

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By Nancy Lapid

Feb 20 (Reuters) - Hello, Health Rounds Readers! Today we have some comforting news for women that could result in many fewer cases of cervical cancer that needlessly go undetected. We also feature a study that found minimal benefit to Pfizer's COVID-19 treatment in vaccinated older patients.

Swabs can replace speculum screening for HPV

Women can safely skip the unpleasant speculum-based exam for human papillomavirus screening and instead test for the virus themselves using a vaginal swab, two new studies confirm.

Genital HPV infections are thought to be responsible for more than 99% of cervical cancers. At least partly because the speculum exam can be uncomfortable or even painful, “half of the women in the U.S. who have cervical cancer did not undergo a screening test in the past ten years," Dr. Diane Harper of the University of Michigan, who led both studies, said in a statement

"We should try to make (the test) a more comfortable experience,” she added.

Countries that have adopted self-screening for HPV, including Sweden, Australia and the Netherlands, have also reduced their incidence of cervical cancer, Harper noted.

The researchers recruited 193 women, ages 25 to 65, and instructed them to use vaginal swabs, which were then sent to the laboratory. The volunteers also underwent speculum exams.

Testing of all the samples for 15 high-risk HPV types showed that “using swabs is equivalent to speculum-based collection,” Harper said.

The swab test results, as reported in Preventive Medicine Reports, were in agreement with global data on HPV prevalence, reinforcing the usefulness of vaginal swabs, the researchers said.

A separate study published in JAMA Network Open, involving 56 women with physical disabilities, found the vaginal swabs to be equally effective and much less painful and traumatic than speculum-based screening.

“The swabs cannot replace having a conversation with your doctor. However, it can save the vast majority of women from getting unnecessary speculum tests,” Harper said.

Paxlovid benefit in vaccinated seniors proves minimal

Pfizer’s anti-viral Paxlovid provided little protective benefit against severe COVID-19 in a study of the treatment in older Canadians who had been vaccinated against the virus, researchers reported on Thursday in JAMA.

For eight months in 2022, the province of Ontario, Canada restricted the use of Paxlovid to symptomatic, COVID-19-positive adults aged 70 years and older, unless patients were immunocompromised or had other risk factors.

During that period, among 1.6 million vaccinated Ontario residents ages 65 to 74, the policy to restrict Paxlovid to those aged 70 and older resulted in a more than doubling of Paxlovid prescriptions, but no improvement in COVID-related hospitalization, all-cause hospitalization, or all-cause mortality in that age group, according to the report.

“Our study effectively rules out the notion that Paxlovid causes large reductions in COVID-19 hospitalization in vaccinated older adults,” study leader Dr. John Mafi of the David Geffen School of Medicine at UCLA said in a statement.

A course of the two-drug treatment costs well over a $1,000, he noted.

“While we cannot rule out a small reduction in COVID-19 hospitalization, our results indicate that at best, Paxlovid’s potential effect on COVID-19 hospitalization among vaccinated older adults is four times weaker than the effect originally reported in Pfizer’s 2022 clinical trial.”

US may be facing critical hospital bed shortage

A reduction in staffed hospital beds is putting the United States on track for a hospital bed shortage, a new study suggests.

In 2024, the national hospital occupancy average was 75%, up from an average of about 64% in the decade leading up to the COVID-19 pandemic, researchers reported in JAMA Network Open.

Rather than being due to an increase in hospitalizations, the rise was driven by a 16% reduction in the number of staffed hospital beds, that is, beds for which staff are on hand to care for patients, the researchers found.

“Our study was not designed to investigate the cause of the decline in staffed hospital beds, but other literature suggests it may be due to healthcare staffing shortages, primarily among registered nurses, as well as hospital closures partially driven by the practice of private equity firms purchasing hospitals,” study leader Dr. Richard Leuchter of the David Geffen School of Medicine at UCLA said in a statement.

To determine the risk of a national bed shortage, the authors estimated annual hospitalizations from 2025 through 2035, taking into account an expected jump in hospitalizations due to an aging U.S. population.

If hospitalization rates and hospital bed supply do not change, average national hospital occupancy could reach 85% by 2032 for adult hospital beds, they found.

“For general hospital beds that are not ICU-level, many consider a bed shortage to occur at an 85% national hospital occupancy, marked by unacceptably long waiting times in emergency departments, medication errors, and other in-hospital adverse events,” Leuchter said.

If there were a sustained national hospital occupancy of 85% or greater, the result could be thousands of U.S. deaths each year that would not otherwise have occurred, he said.