Regular screening is crucial for preventing cervical cancer or identifying cancer at an early stage, when treatment is most likely to be successful. Screening is particularly important for women who did not receive the HPV vaccine; in the UK, that means most women over the age of 30. Many European countries, including the UK, have well established national or regional screening programmes. However, the success of any screening programme is dependent on high uptake, and in many countries screening uptake has been falling over time and is below the target. The use of self-collection of vaginal samples for HPV testing, also termed self-sampling, has attracted growing interest globally as one way to remove barriers to screening and increase screening uptake.
In this review, we examine what the current evidence tells us about the implementation, performance and participation rates of using self-sampling for HPV primary cervical cancer screening. We use the Netherlands as a case study to look at the impact of self-sampling on overall screening uptake, as the Netherlands was the first country to introduce self-sampling as an option for non-responders (women who did not screen when offered the traditional pap-smear).
We also discuss what the evidence says about different ways of offering self-sampling (opt-in vs. opt-out), the relative performance of primary HPV testing in self- and clinician-collected samples, what self-sampling means for sample adequacy and quality, the difference between test performance, clinical performance and pathway performance, and the importance of adherence and loss-to-follow-up when considering comparative performance. This information can help inform decision making and understanding in this area, and the review also highlights current evidence gaps needed to inform policy decisions.
The full paper is now available open access on the Future Oncology website. Aquarius is passionate about improving women’s health, and has worked with many clients and organisations on improving screening, vaccination and outcomes in cervical cancer, including exploring how self-sampling can address many of the unmet needs in different populations and settings. We continue working in this disease area at the local, national, regional and international level (including with the WHO and UNFPA), and would love to hear from you if you have a challenge in this area that you would like support on.
Citation
Huntington S, Smith JS, Nuttall D et al. Evidence from Europe on implementation, participation and performance of self-collection for cervical cancer screening. 2024. Future Oncology, 1–12. https://doi.org/10.1080/14796694.2024.2409625
To learn more about our work at Aquarius, please visit our website or email us at info@aquariusph.com
Article by Susie Huntington October 2024