Spectator Health

How self-testing can help beat cervical cancer

21 August 2014

Self-testing is now available to any individual wishing to rule out conditions such as diabetes, pregnancy and bowel cancer.

Traditionally, however, screening for cervical cancer has required women to attend a GP surgery in order to have a small sample of cells scraped from the surface of their cervix by a doctor or a nurse. The sample is then sent to a laboratory to assess the cervical cells for any abnormalities (cytology testing) and/or to test for human papilloma virus (HPV) DNA.  Some types of HPV may cause cervical abnormalities that can subsequently go on to develop into cervical cancer. Several studies over the past decade have also demonstrated the superiority of HPV DNA testing over cytology.

Around 20 per cent of women do not attend cervical screening for a number of reasons including, for example, difficulties relating to travel, childcare, work commitments and problems in accessing screening at an appropriate time and place. Others are put off by the potential embarrassment and discomfort of the whole process.


But all that could be about to change. Important work undertaken in both China and Mexico over recent years has highlighted the potential of self-sampling for HPV DNA. In some recently published research on 100,242 Mexican women aged 25-75 and from low-income backgrounds, 11% (10,863) self-tested positive for HPV DNA.

In a study due to be completed later this month women attending five surgeries in London have been offered the option of self-testing for HPV using a swab. The self-sampling can be undertaken at the individual’s home as opposed to at the GP surgery.

In addition a separate analysis of 36 studies comparing the accuracy of HPV DNA testing on self-collected samples in comparison to clinician-collected samples has been published. Form this it seems that self-sampling can be as good as sampling by a doctor or a nurse if the subsequent DNA analytical method is of a sufficiently high quality.

Cervical cancer remains the most common cancer in women under the age of 35 years and the last decade has seen an increase in rates amongst younger women. Perhaps offering more convenient and acceptable approaches to cervical screening might help to reverse this trend.

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  • elizabeth52

    The Dutch Health Council has recommended a new screening program, they’ll ditch their 7 pap test program, 5 yearly from 30 to 60, and offer instead 5 HPV primary tests or HPV self-testing with the Delphi Screener, at ages 30,35,40,50 and 60 and ONLY the roughly 5% who are HPV+ will be offered a 5 yearly pap test. (until they clear the virus) Some women may only have one test, those HPV- and confidently monogamous or no longer sexually active.
    This will save more lives and takes most women out of pap testing and harms way.
    It’s disgraceful that many countries block any form of self-testing and evidence based testing, they’d prefer women to go without unless they agree to an invasive test carried out by a doctor or nurse and follow the official program/recommendations. Population pap testing has unnecessarily worried and harmed large numbers of women, but no one seems to care about that.

    No country in the world has shown a benefit pap testing those under 30, but this group produce the most false positives. Yet many countries ignore the evidence and urge young women to screen, others over-screen as well, ensuring high false positive and referral rates for excess biopsies etc.
    Australia is still telling women to have 26 (some have even more) pap tests, 2 yearly from about 18 to 70, needless to say we have huge and hidden excess biopsy and over-treatment rates. It’s an example of bad medicine.

    There was never a need to worry and harm so many women. There has also, been no respect for informed consent and even consent itself is violated; (“you need one for the Pill”…no, you don’t or, “all women must screen”…No, that’s our decision, it’s an option, nothing more) the entire emphasis is on reaching screening targets.
    In my opinion, women’s cancer screening is influenced by vested interests who benefit from non-evidence based screening and excess, and politics also, plays a part. I rejected pap testing many years ago, I was not prepared to accept much risk at all to screen for a rare event (0.65% is the lifetime risk of cc) while 77% is the lifetime risk of referral for colposcopy/biopsy under the Australian program.
    Damage to the cervix can lead to premature babies, the need for c-sections and cervical cerclage, high risk pregnancy, miscarriages, infertility etc.

    It should be a scandal, it says to me women are still viewed in a paternalistic way by the medical profession and others. (to put it politely)
    I’ve also, declined breast screening, be careful, don’t rely on official sources of “information” IMO, they amount to a sales pitch for screening. The Nordic Cochrane Institute, an independent medical research group, have produced an informative summary on breast screening, it’s on their website.

    Australia is FINALLY talking about changing their cervical screening program, I suspect because more women are walking away from our over-screening program. I wasn’t surprised to hear that the proposed new program will include excess, no doubt to keep vested interests happy, but that means risk to women.

    It sounds like we’ll offer HPV primary testing, 5 yearly from age 25 to 74 – so starting far too early, we should not test before age 30, this early testing will send many young women for unnecessary biopsies. We’ll screen too often, 5 HPV primary tests is sufficient, and screen for far too long, screening should cease at about 60. Also, it sounds like we’ll refer all HPV+ women for immediate colposcopy/biopsy, unnecessary, they should simply be offered a pap test.

    Also, the HPV self-testing option will not be offered until women decline the invasive HPV test for 6 years. The self-testing kit should be an option for all women, many women find speculum exams unacceptable for all sorts of reasons. Post menopausal women can find this exam very painful and it can cause bleeding, soreness etc.
    It’s cruel to put women through invasive testing when something just as reliable is available. It says to me that control over women is the primary concern of the medical profession.
    Thankfully, more women are getting to the evidence and making informed decisions and HPV self-test kits/devices are available over the internet.
    It’s time unacceptable attitudes and poor conduct is addressed in women’s healthcare, it should be focused on what’s best for us, and let’s see some respect for our right to make informed decisions, and yes, that might be a No, thank you.

  • annewareham

    What about the age limits?

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