PhD candidate advocates urine test to screen for cervical cancer

The importance of regular cervical cancer screenings through pap smears is undeniable. Yet, many women shy away from undergoing this critical examination. Despite its potential to detect early signs of cervical cancer and save lives, barriers ranging from fear and discomfort to cultural taboos have led to a reluctance among women to get pap smears.

This is why Loise Nthambi, a PhD student at the University of Nairobi, specialising in microbiology and immunology is advocating the use of urine to screen for cervical cancer.

During her Master’s research, she conducted screenings from HIV-infected women in Makueni County, Kenya, where she found that among the 100 women she studied, 20 per cent had cervical lesions that could advance to cervical cancer. It became evident during this process that many women were not being screened for cervical cancer until it was too late.

“I noticed a pattern from the women I collected samples from. Despite cervical cancer screening being free for women living with HIV, most of them did not go for screening because they said it was painful. Some felt uncomfortable due to their age and the intimate nature of the sampling process. ‘How can a young girl like you want to see me, an old woman? They questioned me while I was collecting their samples. This was back in 2016,’’ Loise shares.

Additionally, there were concerns about male collectors, with some women questioning if their dignity would be respected. Loise says even with self-sampling whereby women are given a kit to collect vaginal swabs on their own and send it back to hospital for testing, women feel like they're going to hurt themselves while collecting the sample.

After her experience, she started researching alternative methods for testing for cervical cancer without conducting a cervical examination.

“I found that Human Papilloma Virus(HPV) which is the major cause of cervical cancer can still be traced  in urine and there are studies that show GenXpert machines, already available in Kenya,  can be used to screen for cervical cancer in urine samples."

Healthcare facilities

Loise highlights the advantages of urine sampling, stating, "It's non-invasive, as collecting urine doesn't require invasive procedures. This increases accessibility, eliminating the need for clinic visits. Individuals can simply be provided with a container to collect urine, which they can then send back for testing, making screening more accessible to underserved communities, especially those in rural areas who may struggle to reach healthcare facilities.’’

This convenience, she argues, can also improve compliance, as it encourages more people to undergo screening. Additionally, she adds that unlike pap smears, which require women to return for screening every three years if their tests are negative, with urine testing, if someone tests negative for high-risk HPV, they only need to return for screening every five years.

However, the new method involves the use of special containers with preservatives designed to preserve DNA regardless of the time of sample collection. This standardisation ensures reliability in testing.

At the moment, Loise hopes her research will complement the body of evidence available to allow the World Health Organisation (WHO) to recognise urine screening as a method of testing cervical cancer.

“Studies shows that early screening is able to reduce cervical cancer burden by over 70 per cent. If accepted by WHO as a standard screening method for cervical cancer, we will be able to reach  the WHO 2030 strategy of screening more than 70 per cent  of women twice in their lifetime by the age of 35 years and by the age of 45 years,’’  she concludes.

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