GPs are urged to offer the self-collection option to all their eligible patients to increase participation in the National Cervical Screening Program for human papillomavirus.
A new study shows that self-collection for cervical screening is both sensitive and highly acceptable for eligible patients who might be at risk of cervical cancer. The study is based on interviews with 45 patients and 18 health professionals who engaged with the self-collection path in Victoria.
Cervical cancer is a highly preventable form of cancer, yet a significant number of people are affected by this cancer. For example, the Australian Institute of Health and Welfare reports that about 800 people were diagnosed with cervical cancer in 2016 and 178 died from this condition in 2018.
In 1991, the Australian government introduced National Cervical Screening Program, which checks for the presence of the human papillomavirus, a known causative agent of cervical cancer. Since the introduction of this program, it is estimated that the incidence and mortality from cervical cancer has been reduced by half.
However, overall, participation rates are estimated to be around 52%, meaning that a significant part of the target population has not been screened. To address this issue, a self-collection protocol was introduced in 2017, as part of the renewed National Cervical Screening Program, which switched from the two‐yearly Papanicolaou smear tests (Pap tests) to five‐yearly human papillomavirus (HPV) testing. The self-collection option is offered as an alternative to the more invasive clinician-led collection method, and is available only to underscreened or never-screened persons.
Despite the availability of this method, the uptake of has been low. In Victoria, for example, only 1067 self-collection tests were performed up until April 2019, compared to 290,000 clinician-collected cervical tests performed during the same time period.
“We’ve been a bit disappointed by the low uptake of self-collection. It really has been a missed opportunity, because 80% of cervical cancers occur in underscreened or unscreened women,” said Prof. Marion Saville, Executive Director of the VCS Foundation, and lead author of the study in a news report.
While the reasons behind this low uptake of the self-screening option are not clear, Prof. Saville thinks that GPs have an important role. In her recent study, Prof Saville found that some GPs find it difficult to determine if a patient is eligible for self-collection, whereas others might not be convinced of the sensitivity of the self-screening option, compared to clinician-led collections.
But a recent meta-analysis has shown that the accuracy of self-collected samples is similar to that of samples collected by clinicians. “The self-collection pathway is evidence-based. It will not lead to an increase in rates of false positives or false negatives for those participating,” said RACGP board director Dr Lara Roeske in a news report.
Furthermore, earlier this year, the Medical Services Advisory Committee (MSAC) advised the Health Minister to expand access to self-collection to include everyone eligible for cervical screening.
“MSAC’s recommendation to widen the eligibility criteria is very encouraging, and if the Health Minister approves it, it will make it much easier for primary care to implement self-collection. It will also improve availability to underscreened and never-screened people,” Prof Saville said.
The key message from Prof Saville’s new study and the recent recommendations is that GPs should feel confident in recommending the self-collection option for all eligible patients.
“The health care practitioner is responsible to offer, facilitate and supervise performance of the self-collection cervical screening test, but this does not prohibit practitioners from allowing participants, after supported decision making and discussions about the test, to take the test home and later bring it back to the clinic, if that is the approach which is most suitable and practical for the screening participant and/or the practitioner,” Professor Saville said.
Amid the COVID-19 pandemic, implementation of the self-collection pathway is ever more relevant. “This also means, in the case of COVID-19 restrictions, that a practitioner could provide a consultation via telehealth then send the kit to the woman,” Prof Saville said.