A “game-changer” DIY cervical screening test that women can do at home could be rolled out on the NHS in a bid to reverse the decline in checks.
The self-testing kit, which is quick and easy to use, could lead to around 400,000 more smear tests being carried out every year, with NHS leaders saying they are looking at making it available in England.
Other countries such as the Netherlands, Australia, Denmark and Sweden have already introduced the self-testing kits.
Cervical screenings – or smear tests – work by detecting human papillomavirus (HPV), a group of viruses which present no symptoms but which can lead to cervical cancer. About 13 high-risk types of HPV are known to cause 99.7 per cent of all cervical cancers.
A trial of the DIY kits, known as the King’s College London YouScreen trial, is the biggest to date and shows how the numbers of women undergoing screening can be boosted.
It asks women to take their own vaginal swab using a long cotton bud – either at home or at their GP practice. In the trial, women who took the test at home then simply posted off their kit for free to a laboratory.
The DIY element eliminates the need for a nurse or doctor to undertake the test, in the hope that women who currently miss their smear test appointments due to embarrassment or concerns about being treated by a male doctor or nurse will be more likely to get checked.
Figures show cervical screening uptake is declining, with nearly a third of women in England – particularly younger women – not taking up their most recent test. Experts say women may refuse testing due to a lack of convenient appointments, worries about the test causing pain and feelings of embarrassment.
A previous survey of 2,017 women by the charity Jo’s Cervical Cancer Trust found young women were embarrassed to attend smear tests because of their body shape and the appearance of their vulva.
The trial results suggest over a million more women could undergo screening every three years in England – or 400,000 more every year – if the DIY tests were rolled out.
Lead investigator Dr Anita Lim, from King’s College London, said: “Self-sampling has been hailed as a game-changer for cervical screening and we now have evidence in a UK population to show that it really is. Women who don’t come for regular screening are at the highest risk of developing cervical cancer.
“Cervical screening participation has been falling in England for over two decades. Currently a third of eligible women aren’t getting screened regularly and in some parts of London this is as high as 50 per cent.
“It is crucial that we make cervical screening easier by introducing innovations like self-sampling, alongside the current cervical screening programme, to help protect more people from this highly preventable cancer. Self-sampling can do this by offering people choice and convenience.”
Published in the journal eClinicalMedicine, the trial included 17,604 kits being sent to people directly through the mail, of which 13 per cent were returned.
Some 10,849 women were also offered a kit when speaking to their GP surgery about something else, of whom 85 per cent accepted and 6,061 (56 per cent) returned a self-sample either through the post or took the test at the surgery. Just over half (52 per cent) of all those who returned a self-sample were at least two years overdue screening, including those who had never previously been screened.
Some 64 per cent were from ethnic minority groups and 60 per cent from deprived populations. The researchers said routine rollout of the kits in England could increase screening coverage from 69.9 per cent to 77.3 per cent.
Dr Lim said: “The YouScreen trial has given us the evidence we need to demonstrate that self-sampling helps get more women screened in England. It’s really encouraging that we received self-samples from groups that have been historically underserved including people from deprived and ethnic minority backgrounds, LGBTQI+, people with learning disabilities and victims of sexual violence.”
Dr Lim said the 13 per cent figure for people returning kits that were mailed to their homes is in line with previous studies but it was exciting that 56 per cent of people returned a kit when offered one at their GP practice. She said this is “very promising in this group of people who haven’t been coming for screening”.
Athena Lamnisos, Chief Executive of The Eve Appeal, told i: “‘Cervical screening rates are at a shocking low of 65 per cent attendance. For a cancer prevention test, that’s something we really need to address with those unscreened and under-screened audiences who have never attended or delayed attendance.
“So this is potentially a game changer in HPV testing and addressing health inequalities. HPV is a virus which is the key risk factor in cervical cancer development. Encouraging HPV self-testing is an important thing to do and will prevent cancers from developing in the long term.
“What’s really exciting about this pilot is that it took place in the real world – so we have evidence about how patients reacted to being offered self-testing. The take up from patients offered self testing by their GP when they presented for other things and were flagged as not up to date with their cervical screening, are so encouraging.”
The NHS invites women for screening every three to five years depending on their age, or more frequently if HPV is detected, and screening is known to save thousands of lives every year. If HPV is found, women may be invited back for another test in a year or have a different test to look at their cervix.
Hannah Tharmalingam, National Clinical Adviser at Macmillan Cancer Support, said: “This feels like a big step forward in increasing people’s confidence to do the test, from the comfort of their own homes. It’s really positive to see steps being taken to ensure healthcare revolves around the person and what they might need.”
NHS director of screening and vaccination Deborah Tomalin said: “It’s extremely promising that this study suggests simple DIY swab tests could have a really positive impact in supporting more women to take part in cervical screening from their own homes, and the NHS will now be working with the UK National Screening Committee to consider the feasibility of rolling this out more widely across England.
“In the meantime, if you are invited for cervical screening by the NHS, it’s vital that you come forward – it could save your life and remains vital towards our ambition of eradicating cervical cancer in England within the next two decades.”
A Department of Health and Social Care spokesperson said: “It’s crucial that access to screening and tests is made as simple and convenient as possible. This trial shows a ground-breaking new way to screen for HPV, potentially saving the lives of thousands of women who have either delayed or never been screened.
“If we’re going to succeed in our mission to make the NHS fit for the future, we need to catch illness earlier so we can treat it faster.”