Friday 9 December 2022 10:23am
About 3,000 New Zealanders are being given the opportunity to take part in a new study where they can choose to have their cervical screening test at either their doctor’s surgery or in the comfort of their own home.
They are part of a new University of Otago, Christchurch-led, pilot study, backed by Te Whatu Ora’s National Screening Programme, to test the impacts of implementing the newly adopted Human Papillomavirus (HPV) test which is being rolled out as the principal screening test for cervical cancer in Aotearoa New Zealand from next year.
Trial Principal Investigator and consultant gynaecologist Associate Professor Peter Sykes, from the University of Otago, Christchurch’s, Department of Obstetrics, says there’s been an enthusiastic uptake so far, with more than 1,500 people already signed onto the pilot study. Participants are being recruited from 17 GP clinics in the Canterbury, Whanganui and Capital and Coast regions.
“The main aim of the pilot is to identify any issues that may arise with the new HPV test programme before it’s rolled out more widely from next year. It will rigorously examine all parts of the screening pathway, from the invitation to take part, the choice of either at-home or in-clinic testing, right through to how well test results are communicated and whether any follow-up treatments are required and sufficiently actioned.”
People eligible to take part in the pilot study will be contacted by or on behalf of their regular GP clinic. Participants will be given the choice of carrying out the HPV test on themselves at either the GP clinic or at home, or ask their screen-taker to perform a traditional cervical speculum test on them instead.
Associate Professor Sykes says the University of Otago trial is one of three ongoing pilot studies into HPV screening, but the first to offer all these options.
“It will give people more choice and control over the process, which it’s hoped, will lead to a rise in the numbers taking part in the screening programme overall. While most people do have regular smears, some are put off by the invasiveness and discomfort of the current test, the anxiety it can cause, plus the fact it’s not always convenient to access a doctor or nurse to get it done. Carrying out the HPV test on oneself will be empowering, plus takes away some of this embarrassment, anxiety and inconvenience.”
The HPV self-test is much less invasive than the traditional smear test, with no speculum required. The person simply collects a sample from the vagina using a swab, he says.
“The clinician-taken HPV test and the HPV self-test are equally accurate, with several randomised trials showing both offer greater sensitivity for the detection of pre-cancerous abnormalities and therefore greater protection against cervical cancer. What’s more, the advanced sensitivity of HPV testing allows for a longer interval between tests, five years instead of three.”
If the HPV self-test result is positive, people will normally need to return to their screen-takers for a speculum-based test to have a sample taken from the cervix to determine if they need to go to hospital for a further examination. Alternatively, they can choose to have a speculum test instead of an HPV self- test – in which case the same sample can be tested first for HPV, then, if positive, for cytology, meaning the person does not need to return for another screening appointment.
Cervical cancer is an almost entirely preventable disease, yet despite the success of the National Cervical Screening Programme 170 New Zealanders are still diagnosed with it each year, resulting in 50 deaths. A review of the screening histories of those diagnosed with cervical cancer from 2008-2017 revealed that around half had not had a smear test in the five years prior to diagnosis.
The rates for Māori and Pacific people are significantly higher than for non-Māori and non-Pacific; cervical cancer incidence per 100,000 people in 2017 was 9.7 for Māori, 6.1 for Pacific, 5.5 for Asian and 5.7 for people identifying as European/other.
Associate Professor Sykes and colleagues recently completed the 2008-2017 Case Review of Cervical Cancer which found that Māori and Pasifika are more likely to experience barriers to cervical screening prior to their cervical cancer diagnosis when compared to other groups.
“Sadly, chief among these barriers are economic considerations as well as cultural considerations, including building trust and relationships, and a reluctance to undergo a speculum exam. There’s evidence that self-testing is more acceptable for Māori patients than a speculum exam and that the use of self-testing can, with an appropriate approach from health services, lead to a marked improvement in screening participation.
“We also know that right now, one contributor to screening failure is a delayed or inadequate response to an abnormal smear test, including delayed access to follow-on specialist assessment. The new HPV screening test is expected to identify more patients with cervical abnormalities than current tests, increasing demand for follow-up investigations and treatment. An important focus of our pilot study therefore will be documenting patient access to cytology triage and colposcopy and the potential impact this would have on hospital services,” Associate Professor Sykes says.
National Cervical Screening Programme Clinical Director Jane O’Hallahan says the pilot study will help inform the successful rollout of HPV primary screening.
“HPV testing is a better test for primary cervical screening. It will find more pre-cancers and prevent more cases of cervical cancer developing. That’s why we are transitioning to HPV primary screening from July 2023.
“The fact the test can be self-taken will remove many barriers that currently dissuade some people from joining the cervical screening programme. Cytology, or examining cells from the cervix, will still play an important role as a secondary test for participants who are HPV-positive, in determining whether the HPV virus has already caused cellular abnormalities.”
For more information please contact:
Associate Professor Peter Sykes
Department of Obstetrics and Gynaecology, University of Otago, Christchurch
University of Otago
Mob +64 21 279 4969