‘Strong support’ for DIY cervical screening tests – poll

NHS officials should consider offering DIY kits to all women who would prefer it to a standard screening, pending ongoing reviews of the tests, Healthwatch England said.

A new poll of 2,400 women who were hesitant about cervical screening found that 73% supported the use of at-home tests if they were made available for free through the NHS.

The NHS offers cervical screening tests – previously known as smear tests – to all women aged 25 to 64 every three years.

But many people do not take up the offer, with a number citing a lack of time, discomfort or embarrassment.

In 2023, almost a third (31%) of eligible women in England did not take up their screening offer.

As a result of low uptake, researchers have launched a number of assessments to see whether kits which can be used at home are a safe and effective alternative.

These kits use swabs which look for the human papillomavirus (HPV) – the virus which is linked to the majority of cases of cervical cancer.

Healthwatch England decided to investigate hesitancy among some women.

It commissioned a poll of women in England aged 24-64 who indicated they hesitant about taking up their next screening offer. The survey was conducted by Savanta between November 2023 and February 2024.

Part of the findings examined how women perceived home-testing kits.

Support for DIY kits was higher among those age 30 to 39 compared with those aged 60 to 64.

Women who responded to the survey indicated that home testing would offer more privacy, avoid discomfort and could be done at a convenient time.

They did express some disadvantages of self-sampling including concerns over accuracy and the inability to ask anyone if the test was being performed correctly.

A previous analysis suggests that offering self-sampling kits to “under-screened” women when they attend their GP practice and by posting kits to women’s homes could boost uptake in England by about 400,000 each year.

People in the YouScreen trial, led by King’s College London in partnership with NHS England, used a vaginal swab, which looks like a long cotton bud, to take their sample, either at home or at the GP practice. At-home tests could be posted to a lab for testing.

People who were found to have the HPV virus were subsequently invited for further tests by a clinician.

NHS England and the UK National Screening Committee are exploring how HPV self-screening could be rolled out more widely.

“Subject to the results of NHS-commissioned research on the safety and effectiveness of self-screening, the NHS should adopt self-screening as an alternative option offered to all women nationally who would prefer it. Instructions for their use should be co-designed with women,” Healthwatch England said in its new report.

Louise Ansari, chief executive of Healthwatch England, said: “Women’s diverse voices and experiences must drive improvements to cervical screening and NHS England’s ambition to eliminate cervical cancer by 2040.

“The strong support for free HPV home-testing represents a major opportunity to increase uptake of screening – we urge NHS England to adopt home testing as an alternative screening solution.

“Until a decision is made on home testing, it’s clear that there should be no one-size-fits-all approach to the delivery of cervical screening. A personalised approach is vital for such an intimate procedure that for many women causes embarrassment or discomfort at best and fear and shame in the worst cases.

“The number one priority for most women was having empathetic and sensitive staff deliver the screening. This includes nurses or doctors who take time to answer questions beforehand, offer practical changes during the exam to reduce pain or discomfort, sensitively handle any past traumatic abuse that makes them fearful of intimate procedures, and who make adjustments for disabled women or people with extra communication needs.

“Women also told us they want more flexible appointment times or drop-in clinics to fit around busy lives involving work or caring responsibilities and we urge screening providers to work with their local Healthwatch to understand their community’s needs.”

An NHS spokesperson said: “These findings add to growing evidence suggesting that self-testing could have a really positive impact in supporting more women to take part in cervical screening from their own homes, and the NHS is 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.”

Healthwatch also called for the health service to address the gap left by the closure of Jo’s Cervical Cancer Trust – the only charity in the UK for cervical cancer.

The NHS should also do more to capture data on characteristics of people who do not take up the offer of cervical screening , it said.

There are around 3,300 new cervical cancer cases in the UK every year.

A Department of Health and Social Care spokesperson said: “It’s crucial that access to screening and tests is made as simple and convenient as possible.

“We welcome this research, and we are working closely with the UK National Screening Committee to explore the potential of self-sampling.

“If we’re going to succeed in our mission to make the NHS fit for the future, we need to catch illness earlier so we can treat it faster.”