Menstrual blood HPV testing accurately detects cervical precancer

By Dr. Liji Thomas, MDReviewed by Lauren HardakerFeb 9 2026

A simple menstrual pad may offer a scalable, non-invasive way to expand cervical cancer screening, matching the accuracy of clinician testing while lowering barriers for women worldwide.

Study: Testing menstrual blood for human papillomavirus during cervical cancer screening in China: cross sectional population based study. Image credit: Pixel-Shot/Shutterstock.com

A recent paper published in The BMJ reports the use of menstrual blood to screen for the virus in precancerous cervical lesions, compared primarily with clinician-collected cervical HPV testing, with cervical cytology as an additional comparator.

Cervical cancer is among the most common cancers among women, with a high mortality rate unless detected early and treated in time. It is primarily due to chronic infection of the cervix with certain high-risk human papillomavirus (HPV) strains.

Cervical cancer persists despite effective HPV screening tools

Cervical cancer is linked to about 348,000 deaths a year. It is almost completely preventable by timely screening and treatment of HPV infection and cervical intraepithelial neoplasia (CIN) of grade 2 or higher (2+).

CIN refers to noninvasive but neoplastic changes in the cervical epithelium. CIN grades are based on the extent of cell abnormalities and epithelial involvement by the neoplastic cells, short of actual invasion. Precancerous lesions are CIN2+, characterized by moderate to severe changes.

Despite this, 661,000 new cervical cancer cases are identified each year, 85 % of them occur in developing countries. Screening typically relies on HPV testing of clinician-collected samples. The reach of such programs is often limited by resource constraints, poor awareness, cultural and religious restrictions and disparities, and fear of test-related stigma or discomfort.

Self-sampling methods could overcome many of these challenges. These include vaginal swabs, tampons, and cervicovaginal brushes. Existing studies show that these can detect 77 % to 96 % of precancerous lesions compared with validated methods. Their specificities are comparable to clinician-collected samples.

Women may still find it difficult to use these methods. Pad-collected menstrual blood could be a noninvasive, convenient test sample.

An earlier study demonstrated a stronger correlation between menstrual blood HPV results and those from clinician-collected cervical samples than with vaginal swabs. While 92 % of participants preferred self-collection, vaginal swabs were unpopular. Thus, 94 % chose the Q-Pad, a menstrual pad with a paper-based dried blood spot strip. In contrast, 23 % chose not to participate because of their discomfort with the use of vaginal swabs.

A pilot study used next-generation sequencing to analyze HPV sampling methods in a cross-sectional study. This supported the comparability of HPV testing results from Q-Pads and clinician-collected samples. The question of menstrual blood sample use for community-scale cervical cancer screening remains open.

Prior studies relied on small samples or non-representative populations, such as hospital patients. Another limitation has been the use of non-standardized collection devices. There is little research on the accuracy of CIN detection via HPV testing on menstrual blood samples compared to clinician-collected samples.

The current study aimed to assess the diagnostic accuracy of menstrual blood for HPV testing relative to clinician-collected cervical samples, in order to detect CIN2+ or CIN3+ or higher grades of cancerous change at the community level.

Community trial tests menstrual blood HPV screening

The study was conducted across seven communities in Hubei Province, China. It covered 3,068 women aged 20 to 54 years with regular menstrual cycles.

The scientists collected three separate specimens from each woman: menstrual blood obtained using a minipad for HPV testing, clinician-collected cervical samples for HPV testing, and ThinPrep cytology samples.

The minipad prototype was developed for this study. It comprised presterilized cotton designed for optimal DNA collection, which would easily stick to the absorbent area of a standard menstrual pad. It was to be detached once it was visibly saturated over more than two-thirds of its surface and returned to the laboratory as instructed.

Any woman who was HPV-positive or had suspicious cytology results was referred for colposcopy and biopsy. Colposcopy is a procedure that uses magnification to examine suspicious, potentially precancerous, cervical features. Women who tested negative on both HPV tests and had normal cytology were not referred for biopsy, as their risk of CIN2+ was considered extremely low, and were instead advised to undergo annual follow-up.

HPV testing targets 14 high-risk genotypes and is used as a screening marker for increased risk of CIN2+ or CIN3+, rather than a direct diagnostic proxy. The Bethesda classification system was used for cytologic results, spanning the spectrum from negative for intraepithelial lesion or cancer to invasive cancer.

Menstrual blood HPV testing matches clinician sample accuracy

Clinician-collected sampling led to positive HPV tests in 337 women, and 408 women were referred for colposcopy. Of these, 52 had CIN1, while 24 and 13 had CIN2 and CIN3, respectively. One was diagnosed with invasive cervical cancer.

HPV testing of minipad-collected menstrual blood identified 94.7 % of CIN2+ lesions. This was comparable to clinician-collected samples, at 92.1 %. Both had similar specificities of 89.1 % and 90.0 %, respectively. Conversely, cytology had a higher specificity of 96.2 %.

The negative predictive value for both HPV test samples was 99.9 %. Meanwhile, the positive predictive value was 9.9 % versus 10.4 %, respectively.

HPV testing and cytology methods had comparable sensitivities for CIN3+ detection, 92.9 % for minipad-based testing and 85.7 % for clinician-collected samples and cytology. The specificities were 88.5 % and 89.4 % for minipad-based and clinician-collected samples, respectively. Both samples yielded similar negative and positive predictive values and had identical colposcopy rates, 28.1 per diagnosis.

HPV testing based on minipad samples met predefined non-inferiority criteria compared to clinician-collected samples. HPV genotypes and their proportions were similar in both. HPV 16 and 18 were identified in 37.5 % of minipad-based HPV-positive tests, compared with 31.8 % using clinician-collected samples. Multiple HPV strains were identified in 46.8 % and 43.3 % of samples, respectively. Both sample types also yielded comparable results with age-stratified analyses.

Complete genotype concordance, both sample types showing the same HPV genotypes, was observed in 96.2 % of participants, with discordance in 2.3 %. Including partial concordance, some but not all strains reported in both samples, 97.7 % were concordant, indicating excellent agreement.

In the subgroup with HPV positivity in the menstrual blood sample, complete concordance was observed in 73.4 % of minipad samples, 12.3 % showed partial concordance, and 14.2 % were discordant. Among those with HPV-negative results, 99.3 % were completely concordant, and 0.7 % discordant. Both had comparable screening efficiencies, the number of colposcopy referrals required to detect one case of CIN2+ or CIN3+, at 10.1 versus 9.6, respectively.

The protocol showed a very high negative predictive value, suggesting that very few high-grade lesions were missed within this screening pathway. Adopting the use of the Early Test app alongside led to improved communication of the results with the patients.

Earlier studies showed that women in low-resource settings in India strongly preferred HPV testing in menstrual blood. In addition to highly sensitive testing for oncogenic HPV infection, such methods could encourage women and girls to educate themselves about their health. It could also promote preventive behaviors, reducing infection and transmission.

The authors comment, “This psychological alert effect can transform screening from passive surveillance to active health management.”

Study limitations include a higher total number of positives due to a broader anatomical sampling area, which may detect HPV infections beyond the cervix and could increase false-positive results and unnecessary referrals. The authors note that future screening programmes may require additional triage strategies, such as repeat testing or the use of molecular biomarkers, to manage the increased positivity. Future studies should directly compare menstrual blood with validated self-samples for HPV testing for accessibility and diagnostic accuracy.

Longitudinal research is also essential to measure the number of cases detected in real-world screening, along with cost-effectiveness and the obstacles to deploying these tools.

Non-invasive HPV testing shows promise for population-scale use

Both menstrual blood and clinician-collected samples had comparable diagnostic accuracy in detecting CIN2+ or CIN3+ by HPV testing. Integrated with healthcare apps like the Early Test platform and with standardized specimen collection, this represents a potentially scalable, patient-friendly, and non-invasive method of large-scale screening. It could widely expand access to cervical cancer screening.

The findings of this study support the integration of menstrual blood based HPV testing into national cervical cancer screening guidelines.

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