Charity calls for faster action on at-home cervical screening: New research conducted by Jo’s Cervical Cancer Trust1 during the pandemic has found that 32% of women would prefer to take an HPV self sample, than attend cervical screening with a clinician. Rising to 62% if it was easy and reliable.
This week is Cervical Cancer Prevention Week (18-24 January) and the UK’s leading cervical cancer charity says that the current, clinician method of cervical screening has become less acceptable and accessible, with coronavirus greatly accelerating this trend.
Cervical screening attendance has been largely falling for the last two decades. Before the pandemic began, one in four women and people with a cervix did not attend when invited2. With NHS pressures, paused programmes across the UK during the early months of the pandemic and increased hesitancy about the test the charity warns that the true picture of attendance is now likely much lower.
It is concerned that existing inequalities in attendance are increasing with those who found it harder to attend before the pandemic disproportionately affected. 88% of women with a physical disability say it is harder to have cervical screening3 and among survivors of sexual violence, only half attend4.
In its research it found one in 10 (9%) said they definitely wouldn’t attend cervical screening now and 22% felt less likely to attend. Higher levels of fear or concern was found among those who have been shielding or living with someone shielding, women from Black, Asian and minority ethnic backgrounds and those overdue screening. Two in three South Asian women say that people at higher risk from coronavirus are better off delaying cervical screening for now5.
Rebecca Shoosmith, Chief Executive (Acting), Jo’s Cervical Cancer Trust: “The pandemic has shown that our NHS is able to innovate quickly and we want to see that extended to cervical screening. More and more people find the current test challenging and coronavirus has accelerated this trend adding more barriers. Sadly those who found it difficult before are likely to be no closer to getting tested. Self-sampling would be a game-changer. We have a roadmap to eliminate cervical cancer and self-sampling is a key part of this, one that will save lives.”
The charity found women who rarely or never book a test are far more likely to prefer self-testing (47%) than clinician-led screening (9%). Similarly women who are overdue (50% vs 18%) and women from Black, Asian and minority ethnic backgrounds (34% v clinician-led screening 26%)6.
Dr Edward Morris, President at the Royal College of Obstetricians and Gynaecologists: “It’s clear from the survey by Jo’s Cervical Cancer Trust that women are concerned about the safety of attending smear tests during the pandemic. We want to stress that it’s incredibly important women do still attend their cervical screening appointments as they can be lifesaving.
“We fully support calls to make cervical screening more accessible and would welcome the introduction of HPV self-testing kits as part of the cervical screening programme. In countries where this is already offered there has been significant success and has increased the screening uptake amongst all women.”
Dr Philippa Kaye, GP and Jo’s Cervical Cancer Trust ambassador: “It’s worrying to think that a further impact of the pandemic could be even lower cervical screening attendance. We want to make it clear that the NHS is open. If you have been invited to make a cervical screening appointment, that’s because your GP has put measures in place to make it safe to attend. Please don’t put it off – if you need more information or support, Jo’s are there for you.”
In 2021, two self-sampling studies are taking place, in London and Dumfries & Galloway7.
Cervical Cancer Prevention Week runs from 18-24 January 2021 and Jo’s Cervical Cancer Trust is launching its smear test awareness campaign #SmearForSmear. The campaign asks people to share lipstick smeared selfies with the message that smear tests prevent cervical cancer. The campaign recognises the challenges to attendance at the moment and is signposting to information and support for anyone who finds the test difficult. www.jostrust.org.uk/smearforsmear
Jo’s Cervical Cancer Trust is the UK’s leading cervical cancer charity, providing information and support to anyone affected and campaigns for excellence in cervical cancer treatment, care and prevention. Its national Helpline is free, confidential and on 0808 802 8000. www.jostrust.org.uk
Research consisted of two waves during 17 June – 13 July and 15-22 September. Included online focus groups, interviews and online surveys.
Samantha Renke, broadcaster and campaigner who has brittle bones (osteogenesis imperfecta) and is a wheelchair user: “I’ve had an abnormal smear test result in the past and I needed a follow-up test during the pandemic. I am at very high risk of getting seriously ill from Covid-19, so I was incredibly anxious sitting in the waiting room for my test, which is scary at the best of times. Self-sampling would have made my experience so much simpler and safer, for me and my personal assistant.
Women with a physical disability are so much more likely to find cervical screening difficult, to the point where it can sometimes be impossible just to get through the door. We shouldn’t have to fight to get this life-saving test. Self-sampling would be so much easier for people like me, who can face huge hurdles such as finding the test really painful or living with a condition that won’t always allow for forward planning. It would allow me to take my health into my own hands.”
Helen, a survivor of sexual violence who founded At your Cervix, a peer support network for people who find smear tests difficult: “When my first invite arrived through the post years ago, my body froze, and I then ripped it up. It took me 10 years to work up the courage to go. For some of us attending a screening is not an easy process, and it won’t be a 2-minute thing. Self-sampling would have meant I could have taken the test in my own time, in privacy – it would have been so much easier.
When rates of sexual violence against women are soaring, I am far from the only person who does not attend because of trauma. If my appointment had been during the pandemic and I could not have brought someone I trust with me to help me, I would never have gone. Other trauma survivors I speak to find wearing a mask triggering, and are putting off attending their test partly for this reason too. A home test could help these women.”
Amanda had stage 1b2 cervical cancer when she was 27 in 2018:
“I had shrugged off going for my smear test – I was embarrassed, I thought the nurse would judge my appearance, and I was scared that the test would be painful. I put it off for a couple of years. When I went, I was referred to the gynaecologist, and eventually diagnosed with cervical cancer. I’m now coming up to the third year since my diagnosis and currently waiting for a PET scan to check for residual disease. The experience has had a huge effect on my mental health. The treatment I had (chemotherapy, and internal and external radiotherapy) means that I’ll never be able to carry my own children and I’m now going through the menopause before the age of 30. If I had been able to do my own test at home, by myself, in just 2 minutes, I might have done it sooner and who knows if my cancer could have been caught at an earlier stage.”
1 Online survey of 2,000 women aged 25-64 living in England, conducted between 17-25 June
5 Online survey of 1,000 women aged 25-64 living in England between 15-22 September. Sample includes 200 women from a Black ethnic background and 200 women from a South Asian ethnic background
6 Online survey of 2,000 women aged 25-64 living in England. Fieldwork took place 17-25 June 2020, hosted by PCP Research & analysed by Claremont