Since being introduced in 1991, Australia’s national cervical screening program has helped to halve the rates of cervical cancer, which can be difficult to cure once diagnosed.
But in recent years, the rates of cervical cancer in Australia have remained stubborn, with about six in 100,000 women being diagnosed each year, the executive director of the Australian Centre for Cervical Cancer Prevention, Prof Marion Saville, said.
It is hoped a new cervical screening self-test being introduced from Friday will improve screening rates and increase detection of the virus that can lead to cervical cancer, preventing more cancers and deaths. It makes Australia the first country to use the self-test as part of an organised national screening program.
What’s the change?
In 2017, the more effective human papillomavirus (HPV) test replaced the pap smear.
Both tests look and feel the same, with an instrument called a speculum inserted into the vagina, and some women can find the test invasive and uncomfortable.
The HPV test is generally conducted every five years and looks for human papillomavirus, which can lead to cell changes in the cervix that can cause cervical cancer. The old pap smear test needed to be conducted every two years, and looked for abnormal cell changes.
Saville said while there are early signs the switch to HPV testing is leading to further cancer prevention, rates of testing could be improved.
Cervical cancer is one of the most preventable cancers, and most women diagnosed with cervical cancer are those who have missed cervical screening opportunities.
“The speculum is a barrier for many people who need screening,” Saville said.
“But pilot studies have shown a very high level of acceptability of a self-test instead among those people who refuse the pap smear.”
What’s the difference between the speculum test and the self-test?
The speculum is used to open up the vagina and cervix, and a swab is then taken from the cervix and sent off for testing for HPV.
With a self-test, a GP will explain to the patient how to collect a sample from the vagina using just a cotton swab. After receiving instructions from their doctor, the patient will go to a private area behind a screen or curtain, or in a bathroom at the doctor’s office, and take their own swab without their doctor present.
The president of the Royal Australian College of GPs, Dr Karen Price, said the test will “be a gamechanger for cervical cancer screening in Australia”.
“It is a positive step forward because it helps our patients to have a choice around how they experience cervical screening, which can be a challenging and uncomfortable experience for many people,” she said.
Who is eligible?
Until now, this self-test had strict eligibility criteria, and was mainly offered to women who had never been screened for cervical cancer or who were overdue. Now, it will be offered to most people with a cervix due for their screening.
Studies have shown this self-test is as effective at detecting HPV as cervical screening done using a speculum.
Prof Karen Canfell, the director of The Daffodil Centre, a joint initiative between Cancer Council NSW and the University of Sydney, said: “It will be available from July 1st for those who are due for their screening and those overdue for screening.”
“So a lot of women would have already had a test for HPV in the last few years and will have tested negative, and so they are not yet eligible.”
Price said for some patients a self-test alone may not be appropriate and a speculum test is still required, including for patients with symptoms suggestive of cervical cancer, people being treated for abnormal cells on their cervix associated with HPV, and patients with a number of other conditions.
Why can’t I do it at home?
Saville said research had shown guidance from a GP was associated with a higher uptake of testing. With home bowel screening tests, for example, some people ignore the test or forget about it, and remembering to then post the test can also be a barrier.
“The cervical screening guidelines, however, do allow the practitioner who’s ordering the test to have that test collected in any setting they think is appropriate,” Saville said.
“So that might mean they say in some situations the kit could be taken home or sent to a home. But importantly, the GP or nurse always gets the results and is responsible for then acting on the results and following up.”
Australia is on-track to eliminate cervical cancer
Canfell said thanks to a combination of HPV vaccination, the cervical screening program, and access to good cancer care, Australia is on track to eliminate the cancer between 2028 and 2035. She said she hoped the self-test would lead to elimination at the earlier end of that range.
“But it’s not just about elimination, it’s about equity,” she said.
“It’s about reaching those groups who often miss screening including Aboriginal and Torres Strait Islander people, LGBTQ+ people, and women from culturally and linguistically diverse backgrounds.
“The hope is the self-test will mean we’re on track to achieving equity, and not just elimination.”
