Papcup: Could this at-home HPV test make cervical screening easier?

By Sadaf Shafagh

Sanziana Foia wants to give women the choice to do cervical screening in the comfort of their own homes. She created Papcup, a self-testing device that detects human papillomavirus (HPV) in minutes, to do just that.?

Unlike the tests offered by the NHS today, Papcup is designed to spot high-risk HPV infections that could lead to cervical cancer in menstrual blood. Once it’s properly trialled and tested, it could remove some of the biggest barriers to cervical screening, helping many more eligible people take part.?

“From talking to women in person, it feels like they want this yesterday,” says Foia, a PhD student at 英国帝国理工学院 .?

Cancer Research Horizons , our innovation arm, has been supporting Foia in her journey to turn Papcup from an idea to a reality.

Key facts about cervical screening

The NHS invites 25 to 64-year-old women, trans men and non-binary people with a cervix for cervical screening (previously known as a smear test or a pap smear) every 3 to 5 years.?

Cervical screening is carried out by a medical professional. This is usually a nurse, who inserts a speculum into the vagina and takes a sample of cervical cells using a soft brush. The sample is then sent off to the lab to be tested for high-risk HPV, which causes almost all cases of cervical cancer. If HPV is found, the sample will be further analysed to check for any cell changes that could lead to cancer if left untreated.?

Screening is for people without symptoms and serves as an important preventative measure, saving thousands of lives every year in the UK. Still, there are some barriers to attending cervical screening. Some people can find the test itself physically and mentally uncomfortable, and others might find it difficult to find the time.?

While these barriers can be challenging, there are lots of tips to make cervical screening easier, as explained in our guide to making screening work for you.

Turning blood samples into answers

According to NHS figures, 1 in 3 people eligible for cervical screening in England don’t attend their appointments, which puts them at the highest risk of developing cervical cancer.?

After Foia’s first cervical screening, she began to wonder if there could be a less invasive alternative to sampling with speculums. Then, she had her period.?

“I was just thinking, do I have to suffer this for nothing? Isn’t there something that could be done with menstrual blood?”?

She was just the right person to ask. Her PhD focuses on using a testing technology called biosensing to monitor whether malaria treatments are working. People with diabetes also use biosensors to monitor the levels of glucose in their blood. Biosensors, she knew, turn blood samples into answers.?

“So, I grabbed a pen and drew a sketch.”?

Two years on, Foia’s now developing the first full Papcup prototype. Uniquely, its biosensors can detect high-risk HPV in menstrual blood taken straight from a pad, tampon or menstrual cup.??

“It’s the most non-invasive approach I could think of for collecting a sample,” Foia explains. “You would be able to decide when to do it, how to do it and where to do it. It would be completely on your own terms.”?

Advances in self-sampling

Separate from Foia’s work, the NHS is testing self-sampling kits that use a vaginal swab (like a long cotton bud) to see how well they work and what sort of difference they can make.?

The recent results of one such trial, YouScreen, suggest giving those overdue for screening the option of self-sampling with a vaginal swab could help the NHS test 1.2 million more people in England for high-risk HPV across a three-year screening cycle. The researchers also noted that they saw more people from historically underserved groups, including people from deprived and ethnic minority backgrounds, LGBTQI+ people, people with learning disabilities and victims of sexual violence, taking part in screening thanks to the trial.??

Because Papcup doesn’t necessarily require any vaginal insertions at all, it has the potential to make an even greater impact for people who menstruate.?

“For women who suffer from sexual trauma, or who might be virgins and feel uncomfortable about inserting anything in their vagina, this is different,” explains Foia.

Samples taken as part of the YouScreen trial also had to be sent to the lab for HPV testing, which can take several weeks to deliver results. Another NHS study, HPValidate, is looking at whether lab tests can detect HPV as accurately in these self-taken samples as they can in cells taken through traditional cervical screening. But biosensors are designed to be used outside labs, and they don’t need scientists to operate them. If trials show it works as intended, Papcup could be like a 2 for 1 special: not only a sample collection kit, but also a testing device.

“You get the test done virtually instantly,” Foia says. “Within 15 minutes you get your results, so you avoid waiting times.”

How Papcup works

Foia knew that the key to innovation was to analyse traditional methods and experiment with new ones.?

With traditional HPV screening, it can take weeks to get results because the tiny amounts of DNA in samples must be ‘amplified’, or repeatedly copied, until they’re big enough for scientists to test them.?Biosensors skip that amplification step. Papcup is designed to only interact with specific levels of HPV in samples of menstrual blood. This interaction creates an electrical current that the device turns into a positive reading.

“There are some very good early indicators that we can make a highly accurate device,” adds Foia, who first tested the idea with a small grant from Imperial College Advanced Hackspace. “We’re actually already close to PCR [the current test] in terms of sensitivity and specificity, which is pretty good for ￡500.”??

But, to fit such advanced testing technology into a portable device, Foia needed some help. So, she did what most of us would do: she asked her mum.?

“I needed someone to help with the shell of the product and the mechanical design and that was all my mum, Nausica Foia. She is the most intelligent, inventive and innovative engineer that I’ve met.”

Taking the next steps with Cancer Research Horizons

Once Foia had Papcup’s design and mechanics in hand, she just needed guidance about how to start a company that could build, test and offer it as a screening tool.?

Cancer Research Horizons supported her entrepreneurial journey by connecting her with a mentor with expertise in cancer and sponsoring her place on the 英国爱丁堡大学 ’s Venture Builder Incubator (VBI) programme.?

The VBI programme provides the opportunity for postgraduate students, postdoctoral researchers and academic staff to develop their startup ideas for three months. Horizons partners with VBI to support academics that aim to use their research for the prevention, diagnosis and treatment of cancer.?

Typically, the VBI programme supports researchers from the University of Edinburgh, but they do offer a few Horizons-funded places for researchers from other parts of the UK. Foia was one of the lucky few.?

“The VBI was my favourite programme. It’s been the best help, the best kind of education I got around building a startup to-date,” she says. “Cancer Research Horizons was the reason I could participate in the first place.”?

The VBI is one of several projects Horizons supports to give academic researchers the time, space and skills to think like entrepreneurs and develop scientific breakthroughs into tools, tests and treatments that can play a part in beating cancer.?

“And when you step out of that land of academia into the land of innovation, things get much more exciting,” Foia adds.?

Future prospects

We still need to learn more about how well different self-sampling and at-home HPV testing methods work before the NHS can start implementing them as part of the cervical screening programme. Papcup isn’t as far along as the self-sampling kit used for YouScreen, but Foia thinks its design, interface and ability to offer quick results give it much more potential.??

The initial version of Papcup is designed to identify high-risk HPV, but further tests will still be required to look for cell changes that could lead to cancer. Although that means some people would still need to attend GP appointments to test cervical cells, it would reduce the strain on the NHS.

“We predict that we might be able to save the NHS about half of what they’re currently spending,” says Foia. “The ultimate goal is to have a win-win-win situation for women, the NHS and Papcup [Foia’s company].”

As part of that all-around win, Foia hopes to develop Papcup until it can identify HPV in samples taken using swabs. That would mean it could be a screening option for women and people with a cervix who don’t menstruate, too. Beyond that, she plans to uncover ways of using Papcup’s biosensors to spot cell changes that could turn into cancer, as well as HPV.?

“Our end goal is a full smear test alternative,” she explains. “The initial version of Papcup is just the first step on that journey.”?

We’ll be following the journey closely from here.