Self-sampling HPV kits have the potential to screen an additional one million people for cervical cancer.

DIY human papillomavirus (HPV) tests could allow over a million additional women in England to participate in cervical screening over the next three years.

Researchers discovered that providing self-sampling kits to under-screened women during their visits to GP practices, as well as mailing kits to their homes, could increase the number of women screened in England by approximately 400,000 annually.

The trial was conducted by King’s College London in collaboration with the NHS Cancer Alliances in North Central and North East London, NHS England, and the NHS Cervical Screening Programme. It was sponsored by University College London and funded by the Cancer Alliances for North Central and East London, with additional support from Cancer Research UK.

This trial represents the first time self-sampling has been offered as part of the NHS cervical screening programme and stands as the largest self-sampling trial for cervical cancer conducted in the UK to date. The self-sampling kits could be used at GP practices or in the privacy and comfort of individuals’ homes.

The results, published today in eClinicalMedicine, demonstrate that this simple and convenient test is an effective solution to address the issue of declining cervical screening attendance. Cervical cancer is highly preventable through screening and treatment of pre-cancerous conditions, with those who do not attend screenings or attend infrequently being at the highest risk of developing the disease.

Self-sampling has been hailed as a game-changer for cervical screening and we now have evidence in a UK population to show that it really is.

Lead investigator Dr Anita Lim

Women who do not participate in regular screenings are at the greatest risk of developing cervical cancer. Participation in cervical screening has been declining in England for over two decades; currently, nearly a third of eligible women are not getting screened regularly, with some areas in London seeing rates as high as 50%.

“It is crucial that we make cervical screening easier by introducing innovations like self-sampling, alongside the current cervical screening programme, to help protect more people from this highly preventable cancer. Self-sampling can do this by offering people choice and convenience.”

Self-sampling has already been implemented in several countries, including the Netherlands, Australia, Denmark, and Sweden, with the goal of increasing cervical screening participation rates.

Emerging evidence from other studies indicates that self-sampling tests are equally effective at detecting HPV, which can lead to pre-cancerous cells. Participants in the trial used a vaginal swab, similar to a long cotton bud, to collect their samples either at home or at the GP practice. Samples collected at home could be mailed for free directly to the laboratory for testing. If HPV was detected, a follow-up test was necessary.

The YouScreen trial provided HPV self-sampling kits to over 27,000 un- and under-screened women and individuals with a cervix, aged 25 to 64, from 133 GP practices in north and east London between January 2021 and November 2021. A total of 8,838 individuals submitted self-samples; 64% were from ethnic minority groups, and 60% came from deprived populations. Among those who received kits by mail from the screening programme, 13% returned them, while 56% returned kits offered at their GP practices.

The standard cervical screening test is an intimate procedure, and there are numerous barriers that may prevent individuals from attending, despite its potential to save lives. Some may feel embarrassed or fear discomfort, while others might have experienced past trauma or have physical or personal reasons that make attendance challenging. In some cases, it’s simply a matter of having a busy lifestyle and not finding the time to schedule the test.

Feedback from GP practices and trial participants was overwhelmingly positive, with reports indicating that self-sampling enabled screening for individuals who had not previously participated.

Dr Lim added: “The YouScreen trial has given us the evidence we need to demonstrate that self-sampling helps get more women screened in England. 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+, people with learning disabilities and victims of sexual violence.”

We are well on our way to turning cervical cancer into a rare disease in the UK. This is thanks to a world-class cervical screening programme, the HPV vaccine and the ability to now test for HPV.

Professor Peter Sasieni, head of the research group at King’s and now at Queen Mary University of London

She continued: “Unfortunately, women born before 1990 are unlikely to benefit from the HPV vaccine so regular screening is vitally important to protect those who have not been vaccinated from this cancer.”

“YouScreen showed that this simple test is popular with both women and GP practices and could boost screening participation in England by over a million over three years. That in turn would help to accelerate the decline in cervical cancer rates.”

Mairead Lyons, a Senior Consultant to YouScreen from King’s College London, said: “Self-sampling is a win-win for everyone. YouScreen demonstrated that for GPs, nurses and other healthcare professionals at general practice, being able to offer self-sampling to under-screened women when they attend for other appointments is a pragmatic way to deliver cervical screening to those at risk.”

Miss Alexandra Lawrence, from the North East London Cancer Alliance and consultant gynaecological oncologist at Royal London Hospital (Bart’s Health NHS Trust), said: “Self sampling was hugely popular with women and in primary care during the YouScreen study. Introducing this option will help to address the low uptake of cervical screening in our area of London. Early detection is so important for all cancers and cervical screening enables HPV-related changes on the cervix to be treated before cancer even develops.”

Clare Stephens, GP and Co-clinical director at North Central London Cancer Alliance, said: “In primary care we have been working for a long time to improve the uptake for cervical screening. The results from YouScreen show that we can make a significant difference to the uptake of screening by offering an alternative self-sampling test instead of a screening appointment within the GP practice. We are glad to have supported the project with funding, stewardship and the engagement of local GPs.”

NHS director of screening and vaccination, Deborah Tomalin, said: “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.

“In the meantime, if you are invited for cervical screening by the NHS, it’s vital that you come forward – it could save your life and remains vital towards our ambition of eradicating cervical cancer in England within the next two decades.”

Sources:

https://www.kcl.ac.uk/news/self-sampling-hpv-kits-could-screen-an-extra-million-people-for-cervical-cancer