Cervical cancer screening has traditionally been the remit of GPs and/or gynaecologists but (to much relief) at-home sampling through the NHS may soon be on the way for many people in the UK, following remarkable results found during research into the effect of self-testing on screening rates.
Cervical cancer ranks as the 14th most common cancer among British women and people in possession of a cervix, with infection with the human papillomavirus (HPV) being a significant risk factor in developing this disease (approximately 13 high-risk HPV types are responsible for 99.7% of all cervical cancers). In the UK, around 3,200 women are diagnosed with cervical cancer each year, with 850 succumbing to the disease.
Amanda Pritchard, the head of NHS England, has committed to eradicating cervical cancer by 2040 through enhanced screening and vaccination efforts. The cervical cancer vaccine doesn’t specifically vaccinate against cancer, but stopping the pathogen which accounts for almost all cancers is a proxy for stopping the development of the disease. Introduced in England in 2008, the HPV vaccination program has been extended to boys and girls aged 12 and 13 since 2019. Despite vaccination, the NHS advises women to undergo cervical screenings every three to five years, as the vaccine does not protect against all HPV strains.
High-profile celebrities such as Jade Goody, who passed away due to cervical cancer in 2009, have done an amazing amount of work raising awareness by sharing their stories and imploring more women get tested. However, recent statistics reveal a decline in cervical screening participation, with nearly one-third of women in England — particularly younger women, those from minority backgrounds, and deprived areas — missing their latest test. While a lack of celebrity cases in the contemporary media may account for some drop in uptake (from a reduction in visibility and awareness), stronger factors are clearly at work.
Indeed, surveys into the topic report that people are deterred from attending their screening for 3 main reasons:
Anxiety or embarrassment about being seen in such a vulnerable state;
Concern about pain or about being treated dismissively – especially with horror stories being told on social media platforms such as TikTok; and
A lack of convenient appointments – with many people working the same hours their local doctor’s surgery is open, it is not easy to fit appointments around work commitments, childcare commitments, etc.
Making home tests readily available should make significant headway in combating avoidance, as performing this test yourself – as and when you want to, and in the privacy of your own home – will alleviate the time constraints and the perceived loss of dignity and control that comes with having it done in a GP’s consulting room.
To study the effect on testing uptake, King’s College London academics conducted the largest UK trial of self-sampling and have detailed their findings in the online journal Clinical Medicine. Approximately 27,000 DIY test kits were offered to women who were at least six months overdue for their cervical screening either at their GP surgery or through the post, and researchers found them - especially those provided by GP surgeries – to significantly increase screening participation, proposing a theoretical increase in screening rates from 69.9% to 77.3% coverage when scaled for the population of England. Among those who returned a self-sample, 52% were at least two years overdue for screening, including some who had never been screened before. Of the participants, 64% were from minority ethnic groups, and 60% were from deprived populations.
“Self-sampling has been hailed as a gamechanger for cervical screening and we now have evidence in a UK population to show that it really is,” said Dr Anita Lim, the study’s lead author and a senior research fellow at King’s College London. “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+ communities, people with learning disabilities, and victims of sexual violence.”
Researchers estimated that the convenience of home sampling could lead to about 400,000 additional women participating in cervical screenings annually. But before home testing can become a standard NHS offering, the UK National Screening Committee must evaluate its efficacy and assess the risks and extent of overdiagnosis. NHS England’s director of screening and vaccination, Deborah Tomalin, stated that the NHS would review the feasibility of a broader rollout in England. “It’s extremely promising that this study suggests simple DIY swab tests could have a really positive impact in supporting more women to take part in cervical screening from their own homes, and the NHS will now be working with the UK National Screening Committee to consider the feasibility of rolling this out more widely across England,” she said.
Sophia Lowes, Cancer Research UK’s senior health information manager, responded to the findings by noting that self-sampling could help overcome some barriers to cervical screening and address health inequalities. “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,” she added. “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.”
Prof. Peter Sasieni, head of the research group at King’s College London and now at Queen Mary University of London, noted that the UK is “well on the way to turning cervical cancer into a rare disease.” He made sure to emphasise, however, that while the HPV vaccination in schools is highly beneficial, women born before 1990 still require regular screening due the vaccination drive not yet being available during their school years.