Women could be offered cervical screening themselves through the NHS after research found self-testing At home, screening rates improved significantly.
Researchers calculated that if they could collect a sample at home, about 400,000 more women would be screened for cervical cancer each year.
Cervical cancer is the 14th most common cancer in women in the UK. There are around 13 high-risk types of human papillomavirus (HPV) known to cause 99.7% of all cervical cancers. Around 3,200 women in the UK are diagnosed with cervical cancer 850 people die from the disease every year.
Amanda Pritchard, head of NHS England, has pledged to eliminate cervical cancer by 2040 through screening and vaccination.
The HPV vaccination programme was introduced in England in 2008 and has been offered to both boys and girls aged 12 and 13 since 2019. The NHS encourages women to have a cervical screening every three to five years, even if they have been vaccinated, as the jab does not protect against all forms of HPV.
But latest figures show that uptake of cervical screening is falling, with almost a third of women in England – particularly younger women, women from ethnic minority backgrounds and those from deprived areas – not having their most recent test.
Women sometimes choose not to go for a screening because they are ashamed, afraid it will hurt or because there is no suitable appointment.
Academics from King’s College London conducted the largest trial of self-sampling in the UK to date. Published in the journal eClinicalMedicine, the trial looked at 27,000 women who were at least six months overdue for their cervical cancer screening. They found that DIY kits, particularly those given directly to women by their GP, can significantly increase their uptake of screening.
“Self-sampling has been hailed as a game changer for cervical cancer screening and we now have evidence in a UK population to show that this is indeed the case,” said Dr Anita Lim, the study’s lead author and a senior researcher at King’s College London.
“It is really encouraging that we have received self-samples from groups that have historically been underserved, including people from disadvantaged and ethnic minority backgrounds, LGBTQI+, people with learning disabilities and survivors of sexual violence.”
Before home testing can be routinely offered by health services, the UK National Screening Committee must evaluate its effectiveness and assess the risk and extent of overdiagnosis.
Deborah Tomalin, director of screening and vaccination at NHS England, said the NHS would assess whether self-swabbing could be rolled out in England. “It is very promising that this study suggests that simple DIY swab tests could have a really positive impact on supporting more women to take part in cervical screening at home, and the NHS will now work with the UK National Screening Committee to consider the feasibility of rolling this out more widely in England,” she said.
During the study, 17,604 vaginal smears were sent to women by post, while 10,849 women were offered a kit when they spoke to their GP about something else.
The study found that 56% of people who were offered a DIY test by their GP, and 13% of people who had a self-test sent in by post, returned their screening test. 52% of people who had sent in a self-test were at least two years overdue for screening, including those who had never been screened before.
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Sixty-four percent belonged to ethnic minority groups and 60% to disadvantaged population groups.
The study found that expanding self-sampling in England could increase national screening coverage from 69.9% to 77.3%, resulting in more than 1 million extra women being screened in England every three years.
Prof Peter Sasieni, head of the research group at King’s College London and now at Queen Mary University of London, said the UK was “well on the way to making cervical cancer a rare disease”.
He said that while the HPV vaccination in schools had significant benefits, women born before 1990 still needed to be screened regularly because they had not been vaccinated against cervical cancer.
Sophia Lowes, senior health information manager at Cancer Research UK, responded to the findings, saying self-sampling could help to remove some of the barriers to cervical cancer screening and in turn tackle health inequalities.
“If coverage of cervical cancer screening and HPV vaccination increases, it is possible that we could reduce cervical cancer to the point where almost no one gets it,” she added. “More research is now needed to better understand the accuracy of self-sampling and how it can be rolled out effectively to help more people.”