This testing method is reliable and has the potential to reach a large percentage of the people who decline pelvic exams.
Australia is on track to being the first country to eliminate cervical cancer, which we aim to do by 2035.
To accelerate progress towards this goal, a government-funded national cervical screening campaign will kick off in September, promoting the cervical screening options now available to patients across the country. This campaign will be the first of its magnitude in over 20 years and will likely result in an increase in patient demand, particularly for HPV self-collection.
The campaign will be primarily focused on priority patient groups, specifically Aboriginal and Torres Strait Islander women and people with a cervix as well as culturally and linguistically diverse patients, to lift screening rates and improve outcomes for these communities.
Now is the time to contact your laboratory to ensure you have the correct swabs and instructions to offer self-collection as an option to all your eligible patients, and to make sure you know the facts about self-collection so that you can support all your patients in their decision making.
Can self-collected tests be trusted?
There is now a large body of evidence confirming that, provided high-precision PCR testing is used for laboratory processing, self-collected samples are just as sensitive for the detection of CIN2+, adenocarcinoma in situ, and oncogenic HPV as clinician-collected cervical samples. HPV is the cause of almost all cervical cancers. All self-collected samples in the National Cervical Screening Program are processed using PCR technology, which is a regulatory requirement.
Some healthcare practitioners and patients worry that a sample taken incorrectly will not find HPV and therefore present as a false negative. In the laboratory, there are safety controls on the HPV test to ensure that samples taken incorrectly or not at all are reported as “unsatisfactory” rather than “negative”.
The first control is cellularity control. This indicates if there was adequate cellular material in the sample to ensure the result is valid. Therefore, if HPV is not detected, you can be certain this is a true result from a representative sample, and if a patient has returned the swab without taking a sample at all, this will produce an invalid result.
The second control, the assay failure control, ensures there was no inhibition of the PCR reaction by interfering substances such as lubricants or creams, or large amounts of blood or discharge.
The rate of unsatisfactory test results for self-collected samples is low at about 1-2%.
There are also some concerns amongst healthcare practitioners that offering self-collection removes their opportunity to conduct a pelvic exam and visualise the cervix for abnormalities. However, there is no evidence to support the need for a pelvic exam in the context of routine cervical screening in asymptomatic patients. For HPV positive patients, the cervix will be visualised during a follow up appointment for cytology or colposcopy, and any decisions to perform a pelvic examination or visual inspection of the genital tract should be patient-centred, clearly clinically indicated and made collaboratively.
So why should I offer self-collection?
Over 70% of cervical cancer occurs in people who have never been screened or are overdue, making under-screening the major risk factor. Self-collection can make a world of difference in under-screened groups, and offering this option is an important tool in progressing towards the equitable elimination of cervical cancer in Australia.
Evidence shows that self-collection is highly acceptable to Aboriginal and Torres Strait Islander women and people with a cervix, as well as patients of some CALD backgrounds, as it addresses privacy/modesty concerns, embarrassment, fears of discomfort and pain, and prior trauma. Furthermore, a pilot study demonstrated that 85.7% of those who declined a speculum examination were agreeable to providing a sample after being offered self-collection. Self-collection is therefore one of our most effective tools in encouraging patients to undergo regular screening.
Related
The latest data shows that self-collection is being embraced by many patients and healthcare practitioners, with over a quarter of cervical screening tests processed in Australia from Oct – Dec 2023 self-collected.
How do I implement self-collection in my practice?
The first step is to contact your laboratory to ensure you have the correct swabs and instructions for handling self-collected samples.
Secondly, GPs have a key role in introducing and explaining both testing options to their patients and supporting them to make an informed choice about how they participate in screening. Many patients, particularly those from CALD backgrounds, are still unaware of the options available to them. Keep in mind that all asymptomatic women and people with a cervix aged 25-74 who have ever been sexually active are eligible for both tests.
The Australian Government Department of Health and Aged Care has funded ACPCC to undertake a healthcare provider education campaign in anticipation of a patient-facing campaign (coming September 2024).
GPs can ensure their patients are well supported by providing translated resources/how-to guides, telling patients that self-collected samples are taken from the vagina instead of the cervix, and letting patients know that their GP can help them to take their self-collected test if they would like.
There are also various options available to GPs to educate themselves and make sure they are up to speed with the latest guidelines and evidence about self-collection. A number of CPD opportunities, including webinars and online modules, as well as healthcare practitioner clinical resources are available at https://acpcc.org.au/practitioners/resource-hub/.
Dr Rebecca Starkie is a general practitioner and clinic owner. She is the academic coordinator of Teaching and Learning in the Department of General Practice and Primary Care at the University of Melbourne, and an educator with the Australian Centre for the Prevention of Cervical Cancer.
