Non-speculum clinician-taken samples for human papillomavirus testing: a cross-sectional study in older women

Rebecca Landy; Tony Hollingworth; Jo Waller; Laura AV Marlow; Jane Rigney; Thomas Round; Peter D Sasieni; Anita WW Lim

doi:10.3399/BJGP.2021.0708

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A step towards improving cervical screening uptake
Brent P. Venning and Meena Rafiq

Published on: 07 July 2022

Published on: (7 July 2022)
Page navigation anchor for A step towards improving cervical screening uptake
A step towards improving cervical screening uptake
Brent P. Venning, General Practitioner and PhD Candidate, University of Melbourne
Other Contributors:
Meena Rafiq, Academic GP and Clinical Research Fellow, UCL and University of Melbourne
We thank Landy and colleagues for their recent article on non-speculum clinician-taken samples for human papillomavirus testing.¹ This article further validates an approach that may improve participation in cervical screening and coincides with the introduction of an option for a self-collected vaginal sample as part of Australia’s National Cervical Screening Program. This change, which came in on the 1st of July this year, enables women to self-collect a vaginal sample within a general practice to screen for 14 high-risk HPV types.

However, rates of cervical screening are lower compared to the UK. For example, between 2018 and 2020, the estimated 3-year participation rate was 56%, much lower than the 68.9% of women aged 25 to 49 and 75.0% of women aged 50 to 64 screened in the UK. ^2,3

This change acts to increase participation in under-screened groups. In Australia, rates of under screening are greatest for those aged 70–74 (27% vs 61% in 45–49-year-olds), the same group who may benefit from the option of either self-collected or a non-speculum clinician-collected sample in those that prefer it.⁴ Disparities in cervical screening participation occur by remoteness and socioeconomic status, with rates as low as 40% in some regions.³ Strategies such as mailing out self-sampling kits, as tested in a previous RCT by the same authors, hold the potential to overcome limitations in access to GPs, partic...
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We thank Landy and colleagues for their recent article on non-speculum clinician-taken samples for human papillomavirus testing.¹ This article further validates an approach that may improve participation in cervical screening and coincides with the introduction of an option for a self-collected vaginal sample as part of Australia’s National Cervical Screening Program. This change, which came in on the 1st of July this year, enables women to self-collect a vaginal sample within a general practice to screen for 14 high-risk HPV types.

However, rates of cervical screening are lower compared to the UK. For example, between 2018 and 2020, the estimated 3-year participation rate was 56%, much lower than the 68.9% of women aged 25 to 49 and 75.0% of women aged 50 to 64 screened in the UK. ^2,3

This change acts to increase participation in under-screened groups. In Australia, rates of under screening are greatest for those aged 70–74 (27% vs 61% in 45–49-year-olds), the same group who may benefit from the option of either self-collected or a non-speculum clinician-collected sample in those that prefer it.⁴ Disparities in cervical screening participation occur by remoteness and socioeconomic status, with rates as low as 40% in some regions.³ Strategies such as mailing out self-sampling kits, as tested in a previous RCT by the same authors, hold the potential to overcome limitations in access to GPs, particularly in rural areas where difficulties in accessing care have the greatest impact on under-screened groups.

References
1. Landy R, Hollingworth T, Waller J et al. Non-speculum clinician-taken samples for human papillomavirus testing: a cross-sectional study in older women. published online ahead of print, 2022 Apr 7]. Br J Gen Pract. 2022; BJGP.2021.0708. doi:10.3399/BJGP.2021.0708

2. GOV.UK. Cervical standards data report: 1 April 2020 to 31 March 2021. [cited 2022 Jul 5]. Available from: www.gov.uk/government/publications/cervical-screening-standards-data-report-2020-to-2021/cervical-standards-data-report-1-april-2020-to-31-march-2021

3. Australian Institute of Health and Welfare. Cancer screening programs: quarterly data, National Cervical Screening Program [Internet]. [cited 2022 Jul 5]. Available from www.aihw.gov.au/reports/cancer-screening/national-cancer-screening-programs-participation/contents/national-cervical-screening-program

4. Landy R, Hollingworth T, Waller J et al. Non-speculum sampling approaches for cervical screening in older women: randomised controlled trial. Br J Gen Pract 2022; 72(714):e26–33.
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Competing Interests: None declared.

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