HPV self-sampling could help screen one million more women for cervical cancer

By Tim Gunn and Sadaf Shafagh

Do-it-yourself human papillomavirus (HPV) tests could enable over one million more women in England to participate in cervical screening over the next three years.?

Those numbers are based on the results of the YouScreen trial , which provided HPV self-sampling test kits to people who were at least six months overdue for cervical screening .?

Even though the standard in-person cervical screening test (previously known as a smear test) can help prevent cervical cancer and save lives, barriers like pain and embarrassment can sometimes stop people from taking part.

YouScreen has now shown that HPV self-sampling kits, which can be used privately, have the potential to bring the benefits of cervical screening to many more people.?

“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,” said Dr Anita Lim, the trial’s lead investigator, from King’s College London. ?

There are around 3,300 new cervical cancer cases in the UK every year. Almost all of them are caused by high-risk strains of HPV, which can be found through screening. ?

Because screening is such an effective way of preventing cervical cancer, women and people with a cervix who don’t attend screening appointments are at the highest risk of developing the disease. Experts are concerned that the percentage of eligible people taking part in screening has begun to fall recently.?

“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,” Lim said.?

As well as being the largest trial of its kind in the UK, YouScreen was the first time HPV self-sampling was offered as part the NHS cervical screening programme. Another UK study, HPValidate, is now in the final stages of investigating whether self-sampling is as accurate at identifying HPV as the standard screening test.?

On the basis of the evidence so far, NHS England and the UK National Screening Committee are exploring how HPV self-screening could be rolled out more widely.

How does cervical screening work today?

The current NHS cervical screening test is carried out by a trained medical professional. It involves a speculum, which the doctor or nurse inserts into the vagina so they can take a sample of cervical cells using a soft brush.

This sample is then sent to a laboratory, where it is first tested for high-risk types of HPV . If high-risk HPV is found, the laboratory will then test the sample for cell changes. Doctors can treat these changes to stop them from turning into cancer.

The test can also find cancer in its early stages, when doctors have a better chance of treating it successfully.

The NHS cervical screening programme invites women and people with a cervix from age 25 to 64 for cervical screening every 3 to 5 years.

Making cervical screening work for you

Screening is always an individual choice, but Cancer Research UK encourages women and people with a cervix to take part. Most people don’t experience any pain during cervical screening, and there are ways to make the appointment work better for you . When booking, you can also ask for a longer time slot, so you can talk through any concerns you may have.

Cervical screening is for people without symptoms. If you notice anything that is unusual for you, even if you’ve just been screened, speak to your GP.

HPV self-sampling can help tackle health inequalities

People in the YouScreen trial used a vaginal swab (like a long cotton bud) to take their sample, either at home or at the GP practice. Samples taken at home could be posted for free to the laboratory for testing. If HPV was detected, people were invited for a follow-up test with a clinician.?

This approach, which was trialled in five London boroughs, helped thousands of people who were not responding to invites for the current test take part in screening. Across England, that could translate to 400,000 more people being screened for cervical cancer a year, or 1.2 million people across a three-year screening cycle.?

The results also suggest that HPV self-sampling could be an effective way to address health inequalities around cervical cancer , which are linked to the fact that different groups experience different barriers to the current screening test.?

“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, people with learning disabilities and victims of sexual violence.” said Lim.?

In total, 6 in 10 people who took part in cervical screening through YouScreen were from deprived backgrounds. Similarly, around 6 in 10 people who took part were from ethnic minority groups.?

“Trials like this bring us closer to ensuring that everyone can benefit from screening,” said Sophia Lowes, senior health information manager at Cancer Research UK?

“If coverage of cervical screening and HPV vaccination increases, it’s possible that we can reduce cervical cancer to the point where almost no one develops it. Further research is now needed to better understand the accuracy of self-sampling and how it can be effectively rolled out to benefit more people.”?

YouScreen was led by King’s College London in partnership with NHS Cancer Alliances in North Central and North East London, NHS England and the NHS Cervical Screening Programme. It was funded by the Cancer Alliances for north central and east London, with additional supportive funding from Cancer Research UK.?