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Self-collection a potential ‘game changer’ in cervical cancer fight

Medical & health articles | For health professionals 20 Jul 2021
Young women uni lunch break

A Federal Government move to enable self-collected cervical screens could pave the way for GPs to help reach underscreened women and overcome some patients’ barriers to screening.

All women and people with a cervix in Australia may be allowed to self-collect a sample for their cervical screening tests if the Department of Health gives the initiative the go-ahead.

The move would potentially boost testing rates for cervical cancer by making it easier and more comfortable for many more women – including Aboriginal and Torres Strait Islander women, as well as those from culturally diverse backgrounds – to access screening.

“This is potentially a game changer for screening,” said Professor Karen Canfell, director of the Daffodil Centre, a joint venture between Cancer Council NSW and the University of Sydney.

“It’s also about enabling women to take charge of their own health.”

Overdue or never screened

Around 80% of cervical cancer cases are detected in women who are overdue for screening, or who have never been screened. While women in these categories are currently allowed to provide a self-collected sample, the Medical Services Advisory Committee – which advises the Minister for Health on issues such as the effectiveness and cost-effectiveness of medical technologies and procedures – has recommended more general access.

Prof Canfell said not all women may wish to access self-collection and could have their primary practitioner take the sample.

“But the self-collection option will open up new pathways that are more culturally appropriate and sensitive,” she said. “It is hoped that self-collection will enable the development of new models of cervical screening delivery that will suit women from particular groups.”

It is important to emphasise that however the sample is taken, the involvement of the GP in the process will be crucial.

Prof Karen Canfell, director of the Daffodil Centre

Higher cancer rates in Indigenous women

Professor Canfell said new models of delivery co-designed by Indigenous women would be important in achieving equity in our Indigenous populations.

Indigenous and Torres Strait Islander women have historically had lower rates of screening participation and therefore higher rates of cervical cancer. There are many women in Australia from different populations where there may be substantial barriers to screening. This (initiative) offers exciting possibilities for achieving equity in access and outcome in cervical screening.

Prof Karen Canfell, director of the Daffodil Centre

Professor Canfell said it would also provide the fastest way to eliminate cervical cancer in this country.

It is estimated that 933 new cases of cervical cancer were detected in Australia in 2020, and accounted for around 238 women’s deaths that year.

Evidence for self-testing accuracy

Since the introduction of the new testing regimen in 2017, more evidence has emerged on the accuracy of self-collection of samples for testing. This means that a woman can take her own cervical sample instead of having a pelvic examination and sample collection by a clinician.

“That new evidence is from a major synthesis of worldwide data,” said Prof Canfell. “As long as the appropriate laboratory testing process is used, then the sensitivity of self-collected HPV is very similar to collection by a clinician.”

According to the Australian Institute of Health and Welfare, more than 3.1 million people aged 25-74 had a screening HPV test over the two years 2018-2019. This represents a participation rate of 46%.

The number of screening tests performed last year was expected to be lower than in 2019 because the program changed from two-yearly to five-yearly. The influence of COVID-19 on testing rates could not be determined, as 2020 was also the first year impacted by the move to five-yearly screenings.

Screening rates below pre-COVID levels

However, data provided by the Continuity of Care Collaboration (CCC) – an alliance of peak industry and healthcare organisations – suggests cervical screening rates in at least some Australian states have not returned to pre-COVID levels. Their figures, provided by CCC member Pathology Australia, suggest Victoria’s screening rate is sitting at 85% of pre-COVID rates, while Queensland is even lower at 72%.

The CCC has long argued that more needs to be done to highlight the importance of cervical screening.

For more information on self-collected cervical screening, please visit Cancer Council Australia's Clinical Guidelines for Self-collected vaginal samples.