Self-collected cervical screening is a great way to prevent cervical cancer. How can we get more people doing it?

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A smiling young woman sits across from an unrecognizable new client and holds a clipboard and pen ready to record intake data.
  • Early detection of human papillomavirus (HPV) allows for preventative treatment so that cancer doesn’t develop. 
  • Many women in Australia have had access to “self-collection”, where they can collect their own vaginal sample using a swab. However, many don't know this is an option.
  • A recent study found that many women prefer this option while doctors and nurses like having it available. 

Cervical cancer is a preventable cancer — most cases are caused by long-term infection with high-risk types of human papillomavirus (HPV).

Screening aims to detect types of HPV associated with cervical abnormalities and cancer. Early detection allows preventative treatment, so cancer doesn’t develop.

Cervical screening is a reasonably invasive procedure, which requires a doctor or nurse to do a pelvic examination and insert a speculum, a medical tool used to help examine the cervix.

READ MORE | I had my first pap smear where I buy my lipstick, headache pills, hairfood and toothpaste 

Since 2017, many Australian women have had access to “self-collection”, whereby they can collect their own vaginal sample using a small, soft swab (similar to the ones used to collect a COVID test). But many women who are eligible don’t know it’s an option.

Our new study, published today in the Medical Journal of Australia, found many women prefer this option, and doctors and nurses like having it available.

However, it’s significantly underused in Australia. Between 2017 and 2019, only 6 000 of these tests were conducted, out of an estimated one million women eligible.

To prevent as many cases of cervical cancer as possible, we need to find out why this option is being used so rarely, and how can we increase access.

Wait, what’s cervical screening again?

In 2020, the World Health Organization (WHO) called on countries to progress towards the elimination of cervical cancer as a public health problem.

Australia is considered a global leader in preventing cervical cancer. We have an effective HPV vaccination program delivered through schools, and a longstanding cervical screening program.

Copan FLOQ Swab used for self-collection cervical screening in the Australian National Cervical Screening Program

Only 6 000 of one million eligible women used self-collection in cervical screening in 2017-2019. VCS Foundation, Author provided

Having HPV won’t necessarily cause cancer. There are more than 100 types of HPV, and only 14 are associated with it. Having HPV at some point in your life is quite normal. We just need to make sure we pick up any types of HPV associated with cervical cancer.

In Australia, women (and people with a cervix) aged 25-74 are invited to have a cervical screening test every five years. This more accurate test replaced the “Pap” test in December 2017, which used to be recommended every two years.

We know women find the test uncomfortable. For many, other barriers — such as past trauma or cultural sensitivity — prevent them having the test.

In Australia, 72 percent of cervical cancer cases occur in women who are overdue for screening, or who have never been screened. This is concerning, considering only 55 percent of 35-year-old women have been screened at least once with an HPV test. This is below the WHO’s elimination target of 70 perent by 2030.

READ MORE | Your Pap smear and HPV tests are more necessary than ever 

How does self-collection work?

In December 2017, Australia introduced a new screening option where women could take their own samples. This option is only available to women who:

  • are over 30 years old

  • are more than two years overdue (so four or more years since their last Pap test)

  • or who have never been screened

  • and decline a traditional test.

A self-collected test still requires a consultation with a doctor or nurse. But in this supported environment, a woman can collect her own sample.

Self-collection is as accurate as the sample collected by a doctor or nurse. Australian modelling studies suggest self-collection can save lives.

About 6 percent of people who test positive for some types of HPV need to return to their doctor or nurse for a traditional test to look for cell changes. So the main downside is a small percentage of people who’ve done self-collection will also need to return for a traditional test. Another roughly 2 percent of women will require referral to a specialist for further assessment.

Both women and health-care providers support self-collection

Data from overseas suggest self-collection is an effective way to screen women who traditionally haven’t been screened enough (or at all).

One Australian study demonstrated 85 percent of under-screened women who were offered self-collection opted to screen.

Our work with Victorian Aboriginal women indicates self-collection is key to improving the accessibility and acceptability of cervical screening. A review assessing progress towards elimination of cervical cancer for Indigenous people in high-income countries highlighted the critical role that self-collection is likely to play in increasing participation in cervical screening.

Our new study was done in collaboration with cervical cancer prevention organisation the VCS Foundation and the Victorian government. It provides the first insight into what women and doctors and nurses thought about their experience of using self-collection.

Women appreciated the availability of an alternative option — one that addressed many of their barriers. Doctors and nurses regarded self-collection as a “progressive” change, and thought self-collection was effective at re-engaging those who decline a traditional test.

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