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Cervical cancer is preventable! It is saddening to think that in 2021 people are still dying from cervical cancer. Unfortunately, many people are not participating in the National Cervical Screening Program, and currently more than 50% of eligible participants in Australia are overdue for cervical screening.

Here are some of the reasons why many women and people with a cervix remain underscreened:

  • A speculum examination may not be considered culturally safe and can be taboo for women in some cultures
  • Lack of access to a female practitioner
  • Lack of a trusting relationship between the patient and their practitioner
  • A speculum examination may not be possible for people who have undergone female genital cutting
  • A speculum examination can be distressing or unacceptable to many patients who have experienced sexual assault or abuse
  • Difficulties attending a medical centre due to socioeconomic disadvantage or living in a rural or remote area
  • Transgender and non-binary people with a cervix can find a speculum examination physically and/or psychologically traumatic

Given underscreening is the biggest risk factor for the development of cervical cancer, this needs to change… and it could be changing soon!

Cervical screening in Australia has already undergone a major shake-up in recent years with the change to recommendations for a HPV (human papillomavirus) test at 5 yearly intervals, replacing the two-yearly Pap test. One of the major benefits of HPV testing is that asymptomatic underscreened patients who decline a speculum examination can take their own HPV test using a vaginal swab.

Currently, HPV self-collection is only available to people who meet certain criteria (which you can access here). However, Australia is moving into a new chapter from 1 July 2022 when all cervical screening participants will be able to access this simple and effective test. The Australian Government has decided to implement recommendations from the Medical Services Advisory Committee to offer all eligible individuals a choice to screen using either a self-collected vaginal sample, or a clinician-collected cervical sample, accessed through a healthcare provider who routinely offers cervical screening in both cases. If you are interested in learning more about the accuracy of self-collected HPV swabs, click here.

Allowing self-collection for all screening participants is a major breakthrough for reaching underscreened groups and is expected to increase participation amongst people who would otherwise not have accepted cervical screening.

It is unsurprising to me that HPV self-collection is highly acceptable to patients. It overcomes many of the barriers to cervical cancer screening that are presented by the speculum examination…

  • It eliminates the fear of pain or discomfort associated with a speculum examination
  • It gives control and autonomy to the person as they are taking the sample themselves rather than having a test done to them
  • It can be done in privacy without having to expose intimate parts of their body to another person
  • It is more flexible in the location it can be performed
  • It is easy to do – no special skills are required!

And there is research that backs this up… A self-collection pilot study by the Australian Centre for the Prevention of Cervical Cancer (formerly VCS Foundation) and the University of Melbourne found that:

  • 85.7% of participants who had declined a speculum examination provided a sample after being offered self-collection
  • 91.6% of participants who received a positive HPV result completed follow-up testing within 180 days of self-collection

And here are some comments from participants involved in the pilot study…

‘I felt like it would be really intrusive from another person. I just didn’t want to do it with another person in the room, you know, I wanted to do it with the cotton bud because I could do it myself and it didn’t make me feel powerless.’

‘Much easier, peace of mind, quick result and time wise – for time poor people.’

‘Because it’s convenient, it’s helpful. Useful. It avoids all the rigmarole of the whole hoopla. It’s so much easier, it takes all the fear out of it. Like you’re not going to hurt yourself, you know.’

One of the sites of the self-collection pilot study was an Aboriginal Community Controlled Organisation in Victoria. At this site it was found that by empowering Aboriginal women to take control of their screening experience and offering them privacy, self-collection removed feelings of invasion, shame and embarrassment previously experienced during cervical screening. In doing so, self-collection provided a culturally safe alternative for cervical screening for Aboriginal women.

Two Aboriginal women reported feeling empowered after completing the self-collected test on their own:

‘Because of the first experience that I had, knowing that I wouldn’t be put into that position again. Knowing that I could do it in the comfort of myself and then if I needed to then [the nurse] could help or the [women’s’ health desk staff] could help if I needed assistance, but the option was that I could do it myself.’

‘It gives you a sense of control. It was comfortable as a test. I didn’t have to worry about positioning my body as you would for a regular test.’

Several research studies in Australia and New Zealand have shown a high level of acceptability of self-collection amongst First Nations peoples and other underscreened groups. One study by Dutton et al. (2020) found that more than 90% of Aboriginal or Torres Strait Islander women were highly satisfied with the HPV self- collection kit and the process involved.

Further evidence by Creagh et al. (2021) published in MJA shows that:

  • The self-collection pathway was highly acceptable to screening participants and practitioners.
  • Some screening participants indicated they would not have been screened had the pathway not been available.

Professor Marion Saville AM, director of the Australian Centre for the Prevention of Cervical Cancer, has said “This is a real breakthrough, giving autonomy and agency to women, who are now in control of how that test is taken. There’ll still be some people who are used to having Pap smears and are comfortable with that process – that doesn’t need to change if that’s what they want. But there’ll be many for whom this makes all the difference between not being screened and being screened.”

And I wholeheartedly agree.

So, let’s look forward to a time in the future when we can offer HPV self-collection to all of our patients with a cervix, but for now – don’t forget this is currently a screening option for eligible underscreened participants. It is an important tool to have in your toolbox and can help you to reach underscreened populations today!

More information about HPV self-collection can be found on the Australian Centre for the Prevention of Cervical Cancer website.

References:

Dutton, T., Marjoram, J., Burgess, S. et al. Uptake and acceptability of human papillomavirus self-sampling in rural and remote aboriginal communities: evaluation of a nurse-led community engagement model. BMC Health Serv Res 20, 398 (2020). https://doi.org/10.1186/s12913-020-05214-5

University of Melbourne and Victorian Cytology Service Ltd for the Victorian Department of Health and Human Services. Self-collection Pilot Project – improving access to cervical screening for under-screened women. 2017. Available from: https://www.vcs.org.au/wp-content/uploads/2021/07/Self-collection-pilot-project-final-report-.pdf

Creagh N et al. Self-collection cervical screening in the renewed National Cervical Screening Program: a qualitative study. MJA (2021). https://www.mja.com.au/journal/2021/215/8/self-collection-cervical-screening-renewed-national-cervical-screening-program

Australian Minister for Health media release. Landmark changes improving access to life saving cervical screenings. 8th November 2021. Available from: https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/landmark-changes-improving-access-to-life-saving-cervical-screenings

McGregor M. Cervical screening self-collection should be introduced, say experts. The Age. 2021. https://www.theage.com.au/healthcare/cervical-screening-self-collection-should-be-introduced-say-experts-20210729-p58e6x.html

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