Smear tests, also known as a pap screen, are an effective tool in the fight against cervical cancer. By running a small device across the surface of the cervix where the womb meets the vagina, smears can look for specific variants of human papillomavirus (HPV) that can cause changes to the cells and potentially later give rise to cervical cancers. These types are known as “high risk” HPV owing to their potential to cause serious problems later down the line. A vaccine for high-risk variants has proven very effective, but there is still a need for accessible testing.
According to the Center for Disease Control and Prevention, almost all of us will get HPV at some point in our lives because it’s so common among sexually active individuals, with around 100 variants known to be circulating. HPV spreads through skin-to-skin contact such as anal, oral, or vaginal sex with someone who is currently infected. An infection may cause noticeable symptoms such as warts (papilloma means a small wart-like growth), but often people don’t experience any symptoms meaning they don’t know they are infected and are more likely to pass it on.
Catching HPV for most people won’t have a significant impact on your health but catching a high-risk variant is something that merits watchful waiting for early cell changes which can be picked up in a pap smear. The procedure is safe and usually only causes mild discomfort but both mental and physical conditions, as well as cultural obstacles, can make the prospect of a smear an intimidating one for people with a cervix.
To tackle some of these barriers and hopefully boost the number of people having smear tests, the National Health Service (NHS) in England is trialing a do-it-at-home kit that will give people the freedom to test themselves at home. The test is posted to those overdue for a smear test and involves using a long, cotton bud to swab the inside of the vagina which is then sealed in a water-tight container. The test can then be sent for analysis using post boxes which are easy to access in almost all parts of the country. The swab-and-send protocol is similar to existing test kits given out to people who wish to check if they have the sexually transmitted infections chlamydia and gonorrhea.
The tests will be sent to people between the ages of 25 and 64 and if they come back positive for HPV, they will be invited to their General Practitioner who will carry out a more extensive smear test to get a better sample of cervical cells and check these for changes. According to a report from the BBC, last year between April and May around 600,000 tests didn’t happen and with the COVID-19 pandemic still causing delays in the UK it’s likely the backlog of missed appointments - which is usually around 1.5 million - could be even greater than in previous years.
“Self-sampling has been hailed as a ‘game-changer’ for cervical screening that will make screening more accessible and acceptable to women,” reads the YouScreen website that is launching the initiative. “Women can take their own sample for cervical screening, in private and at a time and place of their choosing.
“The fact that women don’t need to have a speculum examination is a key advantage. Self-sampling has already been integrated into the national screening programmes of The Netherlands, Denmark, Australia and Malaysia.”