People are accepting of and prefer self-testing for human papilloma virus (HPV), rather than having a clinician-led cervical smear test, but there is a lack of knowledge about the new cervical screening process, University of Otago—Ōtākou Whakaihu Waka research shows.

Published today in the Journal of Primary Health Carethe research reveals that HPV self-testing (a vaginal swab) was widely accepted and preferred by people for cervical screening, but gaps were identified in their knowledge about the new process.

Lead author Dr. Sally Rose from the Department of Primary Health care and General Practice at the University of Otago, Wellington, says most people chose to be screened using a self-test and the majority found it highly acceptable.

“However, gaps were identified in participant’s knowledge and understanding about the new test, how it differs to the old screening method and what results mean.

“Education, information provision and clear communication at all stages of the screening pathway are important for patient understanding and confidence in this new screening process.”

The National Cervical Screening Program changed in September 2023, with the option to self-test introduced through primary care. People have the option to choose a self-test with a vaginal swab or have a health professional undertake a cervical HPV test (similar to a smear test).

HPV is the major cause of cervical cancer and can be detected from a self-collected vaginal swab with comparable sensitivity and specificity. If HPV is detected, then depending on the result, people will go on to have a clinician-led cervical cytology test (formerly known as a smear test) or be referred to a specialist for further testing.

One of the study’s authors, Associate Professor Peter Sykes from the Department of Obstetrics and Gynaecology, University of Otago, Christchurch, says cervical cancer is one of the most preventable cancers.

“Because we know what causes it, and it takes a long time to develop with a pre-cancerous phase that can be treated; by taking part in screening, a simple test can detect whether a person has certain ‘high-risk’ types of the human papilloma virus that might go on to cause pre-cancerous cell changes for a small proportion of those infected.

“It is important to know that even if you get an HPV detected result, this does not mean you have cancer, but it is an opportunity for further checks, monitoring or treatment to prevent cancer.”

Numerous studies have shown to date that self-testing for HPV is preferred by many people. Historically, Māori and Pacific people and those living in higher socioeconomic deprivation have been under-served by the National Screening Programme, so it is hoped the new process will improve screening coverage in these populations.

Associate Professor Sykes says the uptake of new self-testing has been high in Aotearoa, New Zealand. “We are leading the way internationally, making this research of particular importance.

“Most people who get cervical cancer have not been adequately reached by the cervical screening program and have not had regular cervical screening tests, so research regarding the acceptability and conduct of screening that can inform policy and increase uptake is crucial.”

The research team carried out an online survey in September last year to find out from a large group of people involved in a primary care pilot study about their experience with the new HPV primary cervical screening pathway.

More than 900 (921) people participated in the follow-up survey with 92% choosing a self-test and 10% returning an HPV detected result.

Of those who self-tested, most reported a positive experience, agreeing that they found it easy and comfortable. They were confident they had done it correctly, and felt well supported, despite only a minority having done a self-swab in the past.

Dr. Rose explains that while most people felt well informed during their screening experience, about 20% identified something they were unsure about or thought wasn’t well explained. “Our survey findings support suggestions made by HPV screen-takers that ongoing health promotion and educational activities are needed to accompany the shift to the HPV primary screening pathway.

“Effective communication with the screen-taker, clear information about the new test and the meaning of results were viewed as important for a good screening experience.”

When asked about future screening preferences, most survey respondents expressed a preference for self-testing (81.8%) and almost half wanted to self-test at home (48.2%). Currently, most self-testing is occurring in primary care.

Associate Professor Sykes says the new test is an important tool in cervical screening. “This new way of screening provides a really important opportunity to reduce inequity in our cervical screening program, increase screening participation and reduce the unnecessary harms from a highly preventable cancer.”