Currently, the UK’s cervical screening programme requires people to go in to their GP surgery where a sample is taken from their cervix by a nurse or doctor. To do this a speculum is used to open up the vagina and a soft brush is inserted to take a sample from the cervix. This is then sent off for testing at a laboratory to see whether high-risk Human Papilloma Virus (HPV) is present, the virus which causes nearly all cervical cancers, and if it is the sample will be checked for signs of changes on the cells which could develop into cancer over time if left untreated.
Cervical screening is estimated to saved 5000 lives each year in the UK by preventing cervical cancer from developing, yet cervical screening attendance is dropping year-on-year. 1 in 3 women and people with a cervix are not attending when invited and in some parts of London this is a high as 1 in 2. It is thought that cervical cancer is almost wholly preventable and the World Health Organisation and the NHS have made a commitment to eliminating it. Yet to do that it is estimated that we need at least 80% of everyone eligible for cervical screening to attend, which is everyone with a cervix between the ages of 25 and 64.
There are many reasons why some people might not attend their screening, from not feeling like they want or need it, fear or embarrassment or screening may be particularly difficult for them to attend or go through because of a range of barriers. For women and people with a cervix who have a physical or learning disability, who are carers and struggle to find the time, people without a flexible and understanding workplaces, survivors of sexual trauma, trans and non-binary people, survivors of FGM and many more may find screening difficult to attend, painful or even traumatic.
To help increase attendance and reduce cervical cancer enough for it to be eliminated, which would be an incredible feat, saving 3000 people from a tough diagnosis each year in the UK and over 850 lives, we need to focus our efforts on enabling the people who have never been screened, or haven’t been screened for a long time to attend. We need to address the individual barriers people face with targeted information, awareness, support and improvements to the screening programme.
This is something The Eve Appeal and researchers across the world have been hoping to do. Today’s news takes us a
step closer to having options out there to help those non-attenders to take the first step on the screening pathway and find out whether they have high-risk HPV. The self-sampling HPV kit is a vaginal swab, like a long cotton bud, which can be done yourself, or done by a nurse or doctor, to get a sample from inside the vagina. This means that women and people with a cervix who haven’t attended cervical screening and find it difficult for whatever reason can, in the comfort of their own home, or privately in the GP’s toilets, take a sample from inside their vagina without a speculum or nurse or doctor present to find out if they have high-risk HPV. If they take the sample at home they could post it for free directly to the lab for testing.
If they did have high-risk HPV they would need to go into the GP surgery to have a standard cervical screening test done so that their cervical cells can be checked for any signs of cell changes. Further tests can be done to see whether cell changes need to be monitored or treated. 13 in every 100 people who go for their screening get a positive result for high-risk HPV, so for the majority the self-sampling kit will be all they need to do.
The trial of HPV self-sampling was run in 133 GP practices in north and east London and led by King’s College London. Women and people with a cervix who were at least six months overdue their screening test were offered HPV self-sampling, either by being contacted by post or being opportunistically offered the test when they were at the GP for another reason. Throughout the trial the test was offered to 27,000 people. 56% of people offered the HPV self-sampling test when they were at their GP surgery for something else took up the offer (of these, 65% did the self-test), and 13% of people took up the test when contacted about it via post.
The trial got overwhelmingly positive feedback both from the women and people who used the HPV self-sampling test and from the GP surgeries who took part. Of the people who took up the test when offered, 64% were from minoritised ethnic backgrounds, 60% from areas of deprivation, as well as people from the LGBTQ+ community, people with learning disabilities and survivors of sexual violence.
The results estimate that if self-sampling was rolled out on the NHS widely and offered to all those who haven’t attended their screening for six months or more it could enable more than a million more women to get tested for HPV in three years.
Athena Lamnisos, CEO, The Eve Appeal, says: “We have a huge opportunity to eliminate cervical cancer. We know that screening is vital and HPV testing is key to this. There are so many different reasons why people find screening difficult and don’t attend, so making HPV testing easier to do is a fantastic step forward. This pilot took place in primary care. We now have evidence from real people, in under-screened populations about how they would respond to self-sampling. That really is a game-changer. It’s still really important that you attend your cervical screening test when invited, we have lots of information to help make the appointment more manageable and our nurses are always here to help. ”
Self-sampling has already been introduced in several countries including The Netherlands, Australia, Denmark and Sweden.
If you have any questions or concerns about HPV, cervical screening or any follow up, our Ask Eve nurses are here to chat to for free and confidential information and support. You can email or call them on nurse@eveappeal.org.uk or 0808 802 0019.
You can find the full paper here: Opportunistic offering of self-sampling to non-attenders within the English cervical screening programme: a pragmatic, multicentre, implementation feasibility trial with randomly allocated cluster intervention start dates (YouScreen)’ is published in eClinicalMedicine