A new way for people to take part in the Cervical Screening Test started this year, with self-collection available to everybody across Australia since July. This means that all women and people with a cervix aged 25 to 74 now have the choice to screen either by a self-collected vaginal sample or a clinician-collected sample from the cervix, accessed through a healthcare provider in both cases. Professor Saville AM is Executive Director at the Australian Centre for the Prevention of Cervical Cancer, she explains how self-collection could help to reach under- and un-screened people.
“In December 2017, the Cervical Screening Test replaced the Pap test as the method of screening to prevent cervical cancer in Australia. Because it is a much more accurate test, we believe that it will accelerate our progress towards eliminating cervical cancer, however we have been limited in optimising the program as it is not inclusive for all. We know that the pelvic exam using a speculum for sample collection is a major barrier for people across many cultures, those who experience disadvantage and those who have experienced trauma. Research tells us that self-collection is going to be a very important tool to reach people that we are not currently reaching.
“The important thing to understand about self-collection is that it is just as accurate for the detection of pre-cancer as if a doctor or nurse took the sample with an internal exam. Both options use PCR based tests which are highly accurate and detect human papillomavirus (HPV) – a common infection that causes almost all cervical cancers. For the most part, we want patients to continue to engage in primary care, therefore cervical screening will continue to be available through their nurse or doctor,” said Prof Saville.
A self-collected sample is taken from the vagina (not the cervix). The swab must be inserted a few centimetres into the vagina and rotated for 20 to 30 seconds. The sample can be taken in a private place within a healthcare clinic.
“If a patient opts for self-collection after being offered the choice by their nurse or doctor, they will be provided with a swab, given instructions, and then offered some privacy – whether that is behind a curtain in the consultation rooms or in the practice bathrooms. They will then give the swab back to the practitioner or the reception staff and it is sent to the laboratory. The results are then sent back to their GP.
“If a patient wants to take a swab home, our advice to doctors is to try and get them to do it in the surgery, but if they say no, it is probably a good idea to let them take it home. I’ve been in this role for over 20 years and have been involved in campaigns to raise awareness in various communities to encourage under screened and unscreened people to get tested. At the end of the day, there’s 10-15 percent of people that just won’t have a speculum put in. I think there is a sense of a relief for those people when there is an alternative option. So many people tell us that it is empowering.
“Since July, we have had a major increase in self-collected samples, however we won’t know what that’s done for participation for 6-12 months. I am optimistic that as more and more people hear about the self-collect option, it will be taken up very heavily. In our studies of acceptability, 85% of those who were offered and refused a pap smear gave us a self-collect sample. That’s not 100% but it’s a huge breakthrough in acceptability.
There are still some barriers to get through. For example, we are still limited by patient awareness, and whilst there has been extensive communication and education to primary care, not every practice is ready. However, if we get some patient demand then it will improve access for others. I’m hoping that we get to a tipping point where almost everyone who hasn’t been inclined to participate in screening has a test,” said Prof Saville.