From today, DIY smear tests will be sent to four million women across England who have not turned up for their personal appointment in a bid to increasing cervical cancer screening and saving lives.
Now that I’ve tried it myself – I was one of 27,000 British women who used it as part of a trial – I think it’s a brilliant idea.
It couldn’t have been faster or easier. In fact, I did mine in about two minutes, in the office bathroom, during my morning coffee break.
And like NHS Health chiefs, I am convinced that if all women had the choice, this would increase the number of tests – something that is absolutely needed.
Currently in Britain, women aged 25 to 64 are invited for cervical cancer screening by their GP every five years unless they are considered high risk.
The traditional method involves lying naked from the waist down, with your legs up, while a nurse inserts a tubular instrument called a speculum into the vagina.
This allows them to see the cervix – the opening to the uterus – and take a sample of cells, which are then tested for the human papillomavirus or HPV, which causes 99 percent of cervical cancers.
Personally, I don’t mind. It’s vaguely uncomfortable, but not a problem. But I have friends who find it painful.
Health editor Eve Simmons, pictured, testing a new NHS screening test for cervical cancer that can be done at home or in the office
But more importantly, the screening recording overall isn’t great. Only about 60 percent of eligible women show up for their scheduled test.
Shame is a factor, according to research by Cervical cancer charities. This can be a particular problem for women from certain cultural backgrounds.
But for half of the no-shows each year, taking time off work and finding a convenient time to make an appointment is the reason they miss it.
The new DIY approach will effectively tackle all these problems in one go.
In what is being hailed as a ‘groundbreaking’ next step towards eliminating cervical cancer, eligible women will receive invitations today via the NHS app, text, email or letter.
Once invited, they can order a free kit via the NHS app or their online NHS account.
The self-test kit contains a cotton swab, similar to a long cotton swab, with which a sample is taken from the vagina. The sample is then returned free of charge to the NHS where it is checked for high-risk HPV.
If high-risk HPV – the type that can develop into cancer – is found, individuals will be invited to a follow-up cervical screening appointment at their GP or sexual health clinic, where a nurse or doctor will take a small sample from the cervix to check for cell changes.
It is expected that self-test kits such as this one (pictured) will revolutionize the diagnosis of cervical cancer
The trial I took part in was one of the very first to test interest in the technology, carried out by scientists at King’s College London, in partnership with NHS England.
I offered to try the test, to see if it’s as simple as they think.
And I must admit that I shuddered a little when I decided to take on this assignment.
Like most girls, we were instructed at school to do ‘the mirror test’: you sit on the floor with your legs bent, hold a mirror in front of you and familiarize yourself with your own anatomy.
The exercise is designed to help you notice unusual changes. But I didn’t do it.
Let’s just say it’s not an activity I’ve ever felt the need to spend time on. And I felt anxious, not least at the prospect of having to ‘dig around’ for a sample.
But I had no reason to worry; for starters, there is no speculum involved.
The kit comes in a small box and consists of a cotton swab housed in a small plastic, messed up test tube looking thing.
I took this, along with the instructions – which look like something that might be handed out in a sixth form sex education class – into the toilet.
You take the swab and push it into the vagina about as far as you would to insert a tampon, swirl it for 20 seconds, pull it out, put it in a test tube jar and put that in the post to start analyzing.
There is no pain or discomfort, just 20 seconds of very mild scratching sensitivity – again similar to removing a tampon.
The method is so idiot-proof that according to studies, less than one percent of women do it incorrectly.
The innovation was made possible by a change in the type of test used in cervical screening.
Currently, women aged 25 to 64 are invited to their local GP for cervical cancer screening every five years if they have tested negative for the cancer precursor HPV.
Dr. Anita Lim, lead researcher on the study I took part in at King’s College London, told me: ‘Traditionally, smear tests involved taking samples of cells specifically from the cervix, which were then examined.
“And the person doing the swab needs a speculum to move other parts of the anatomy out of the way, to find it.”
But since 2019, doctors have turned to initial testing for HPV.
The virus is transmitted during sexual activity and is basically endemic. It is believed that as many as eight in ten of the population, both men and women, carry it at any given time.
Usually it is completely harmless. But a handful of the 150 strains can in some cases enter the genital tract, where it causes cells to mutate and become cancerous.
The virus can be found anywhere in the vaginal canal, so taking a sample is easy.
If a smear test is positive for high-risk HPV, further tests will be carried out to determine whether there really is a risk of cancer and whether treatment is needed.
Around the same time as the London trial started in 2021, results from Scottish trials showed that DIY tests – known as self-sampling – were just as accurate as the clinic test.
NHS Cervical Screening data, going back to 2011, shows that uptake was highest that year (75.7 percent), but has fallen over time
And like me, clinicians welcome the proposed rollout.
As Dr Adeola Olaitan, a consultant gynecologist at University College London Hospitals NHS Foundation Trust, said: ‘For years campaigners have wondered why we don’t just let women have their own smear test.
‘In other countries, such as Denmark and Australia, they have been doing it for years. Covid has kicked everything up a notch.”
“This is the future of women’s healthcare – more choice, more freedom,” says Dr Lim. ‘It takes away the invasiveness and shame and instead allows women to protect their own health.
‘There is plenty of robust evidence to show this works, so it was only a matter of time before it became available to NHS patients.’
With the do-it-yourself test, women miss the visual examination that takes place at the GP.
Looking at the cervix is useful for detecting other abnormalities that may go unnoticed, such as infections or non-cancerous growths called polyps.
But according to studies, these so-called incidental findings are noticed in only seven percent of appointments.
It is also important to note that a positive HPV test result does not mean that you have or will develop cancer.
‘HPV is very common in women under the age of 25, and it is extremely rare for it to develop into cervical cancer,’ says Dr Jo Waller, an expert in cervical cancer prevention at King’s College London.
‘In young women, HPV usually goes away on its own and does not cause any problems. Some people compare it to a cold for the genitals.
“More often than not, the immune system clears it up and you would never know you had it.”
About 20 in 100 women have what is called a tilted uterus, where the uterus hinges slightly backwards where it meets the cervix, instead of forwards.
In these cases, inserting a speculum can be very painful. But experts say these patients will also benefit from the do-it-yourself test.
“The beauty of this test is that women are not forced into an uncomfortable position,” says Dr. Olaitan.
‘You don’t have to see the cervix to get the sample. And you don’t have to lie on a bed; you can do it in any position that is easiest.
‘In principle, anyone who can insert a tampon can take their own cotton swab.’
Speaking about the rollout, Dr Sue Mann, National Clinical Director for Women’s Health at NHS England, said:
‘Offering millions of women an alternative test that they can do from the comfort of their own home will be a game changer – making it easier than ever for them to get tested for HPV.
“If you are invited to participate, please order a test. It is a simple swab test that you can do at home in just a few minutes.”
In the meantime, Minister for Health and Social Care Yvette Cooper added:
‘Cervical cancer is preventable, but that’s why we want to make it as easy and convenient as possible for women to keep up with their screening.
‘These free self-test kits are being offered to four million women who are currently behind on their screening, to make it easier for as many women as possible to keep themselves healthy and safe.
‘This is the future NHS we are building – there for all of us when we need it, acting as early as possible to stop avoidable deaths.’
Appointments for cervical screening with a doctor remain the best way to help prevent cervical cancer, but HPV self-testing is being introduced by the NHS as an additional choice, experts say.
The result came in a few days after my self-test.
To be honest, I already knew what it would say, as I had had a normal smear test two weeks earlier: negative – hurray.
Still, I appreciated the reassurance. And all it took was a two-minute trip to the bathroom.
