Each year around five million women in the UK are invited for cervical screening, yet recent figures show attendance is at a 10-year low. Could self-testing kits be a way to ensure that women monitor their cervical health?
Recent annual statistics show incidences of cervical cancer in the UK have risen from eight to nine diagnoses every day. This in turn means 3,224 women faced a cervical cancer diagnosis in 2014. Things are set to get worse, according to modelling work commissioned by Jo’s Cervical Cancer Trust, the only UK charity dedicated to women affected by cervical cancer and cervical abnormalities. This 2016 modelling work presents a bleak prospect, predicting that incidences of cervical cancer are set to rocket if current uptake of cervical screening remains the same; in 2040, incidences will have increased by 16% among 60–64-year-olds and 85% among 70–74-year-olds. In real terms, a 100% increase in mortality among 60–64-year-olds is also a very real threat, rising to a massive 117% if screening uptake continues to decline or fall by a further 5%.
A lack of knowledge about the cause of cervical cancer and who can be affected seems to be contributing to older women (aged 50–64) not attending cervical screening. A recent study showed that almost two-thirds (60%) of women aged 50–64 did not know HPV (human papillomavirus) causes cervical cancer (HPV is a common virus that can cause changes to cells in the cervix that may develop into cancer). In addition, many women failed to recognise historical sexual activity as a threat in that the virus may lie dormant and could develop into cervical cancer later in life.
In addition, the data also showed that 29.1% of women over 50 have found the test painful since growing older, including 24.4% experiencing pain since going through the menopause. This has led to concern that if attendance for cervical screening continues to decline among older women, more will face a later-stage diagnosis of cervical cancer and potentially lose their lives.
The latest cervical screening statistics show that the number of women in Wales, where Pelican Feminine Healthcare is based, attending cervical screening is at a 10-year low. In 2015/16, coverage was only 77.8%, meaning over one in five are not attending this life-saving test.
So what can be done to reverse these trends? Is there something about cervical cancer screening itself that can be changed or altered to encourage attendance? Indeed, can home or self-testing be the solution?
To answer this, we must examine what is involved in the screening process. Cervical cancer screening is usually undertaken by either a nurse or a doctor, who uses an instrument called a speculum inside the vagina so that they can visualise the cervix and obtain a small sample of cells from the surface with a small soft brush
But some women are reluctant to have this test, as they find it uncomfortable, embarrassing or difficult to schedule an appointment with a health practitioner.
In this study, researchers wanted to find out if women who have not been for screening (or who are overdue for screening) are willing to take a test which they can do themselves. The test was offered by their GP when they saw them for other reasons. This test is for HPV, the same reason a traditional cervical cancer screening is undertaken.
As part of the study, researchers also wanted to see if women who test positive in the HPV test at home would come for follow-up tests.
The study concluded that women are happy to accept a self-test kit from their GPs, and that this might be a good way for women who don’t attend routine screening for cervical cancer to be tested.
Out of the 652 women offered a self-testing kit, 443 accepted the test, and out of that 443, 292 returned their samples. The research team then looked at the completed tests. They found that 39 out of 292 women (around 13%) tested positive for HPV while 247 out of 292 women (around 86%) tested negative for HPV. Six of the samples could not be tested as there was not enough DNA in the sample. These women were sent another test.
The women who tested positive for HPV in the study were invited to have further tests. This was either a cervical screening test or a colposcopy. Out of the 39 women, 33 went on to have further tests and two were diagnosed with cervical cancer.
The research team concluded that women who are overdue their cervical screening are willing to be screened using a test they can do themselves. This can only but help increase the number of women having some type of cervical screening.
However, there remains a need for a larger study to validate the results described above. In addition, further work is needed to establish the best way of offering a self-sampling test to women, and whether this type of test would be cost-effective to introduce when compared to traditional or other healthcare solutions surrounding cervical cancer screening.
It is therefore a cautious welcome that needs to be extended towards the emergence of HPV self-testing kits for women. Robert Music, Chief Executive of Jo’s Cervical Cancer Trust, said in response to the Trust’s own research: “The survey shows that for many HPV self-sampling at home may take away some of the anxiety associated with screening. If it could lead to more non-attenders getting tested then we would like to see investment in research to explore its feasibility amongst this age group.”
Of course, in an ideal world, more women should present themselves to healthcare professionals when invited for a smear test or if they have their own concerns about their cervical health. But given the cultural complexity, embarrassment or fear surrounding cervical cancer screening, self-testing kits may be one method to raise awareness of both HPV and cervical cancer, saving women’s lives in the process.
Pelican Feminine Healthcare offers a wide range of single-use gynaecological instruments including the market-leading PELIspec vaginal speculum. In addition, 5p from every box of PELIspec sold is donated to Jo’s Trust. To date, the company has donated nearly £60,000 to help support Jo’s Trust in their mission to make cervical cancer a disease of the past.