Self-sampling HPV kits could screen an extra million people in England for cervical cancer

Do-it-yourself human papillomavirus (HPV) tests could enable more than a million more women in England to participate in cervical screening over the next three years.

The UK's YouScreen trial provided self-sampling kits to test for HPV to women and people with a cervix who were at least six months overdue for their cervical screening.

Researchers found offering self-sampling kits to under-screened women when they attend their GP practice and by posting kits to women's homes could boost the numbers screened in England by about 400,000 each year.

The trial was led by King's College London in partnership with NHS Cancer Alliances in North Central and North East London, NHS England and the NHS Cervical Screening Program.

It marks the first-time self-sampling was offered within the NHS cervical screening program and is the largest trial of self-sampling for cervical cancer in the UK to date. The self-sampling kits could be used either at GP practices or in the privacy and comfort of people's homes.

The results, published in eClinicalMedicine, show this simple and convenient test is an effective way to tackle the problem of fewer people attending cervical screening. Cervical cancer is highly preventable by screening and treating pre-cancer. Those not attending screening, or infrequently attending screening, are at the highest risk of developing cervical cancer.

"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," said lead investigator Dr. Anita Lim.

She added, "Women who don't come for regular screening are at the highest risk of developing cervical cancer. Cervical screening participation has been falling in England for over two decades; currently almost a third of eligible women aren't getting screened regularly and in some parts of London this is as high as 50%.

"It is crucial that we make cervical screening easier by introducing innovations like self-sampling, alongside the current cervical screening program, 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 introduced in several countries—with the aim of increasing cervical screening participation rates—including the Netherlands, Australia, Denmark and Sweden.

Emerging evidence from other studies suggests that self-sampling tests are similarly good at detecting HPV, which can lead to pre-cancerous cells. People in the trial used a vaginal swab, like a long cotton bud, to take their sample either at-home or at the GP practice. Samples taken at home could be posted for free directly to the laboratory for testing. If HPV was detected, a follow-up test was required.

The YouScreen trial offered HPV self-sampling kits to over 27,000 un- and under-screened women and people with a cervix, aged 25-64 from 133 GP practices in north and east London, between January 2021 and November 2021. In total, 8,838 people sent back self-samples; 64% were from ethnic minority groups and 60% from deprived populations. Among those who returned samples, 13% returned self-sample kits mailed directly to them from the screening program and 56% returned a kit when it was offered at their GP practice.

The standard cervical screening test is an intimate procedure. A variety of barriers can stop people from attending, even though it can be a life-saving test. People may be embarrassed or worried about pain, they might have a history of abuse or trauma or have other physical or personal reasons for not coming, and sometimes it's simply having a busy lifestyle and not getting around to it.

Feedback from GP practices and trial participants was overwhelmingly positive, including reports of self-sampling enabling screening in those who have not historically engaged.

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 program, the HPV vaccine and the ability to now test for HPV," said Professor Peter Sasieni, head of the research group at King's and now at Queen Mary University of London.

"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 health care 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 gynecological oncologist at Royal London Hospital (Bart's Health NHS Trust), noted, "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, added, "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."

NHS director of screening and vaccination, Deborah Tomalin, commented, "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."