HPV home tests could improve cervical screening uptake

British Journal of Cancer

Home tests for the human papillomavirus (HPV) could help increase the take-up of cervical screening among women who do not respond to screening invitations, new research shows today.

Despite publicity surrounding Jade Goody who died from cervical cancer at the age of 27, a worrying number of women ignore the opportunity to be screened.

The study,* published in the British Journal of Cancer,** looked at 3000 women from the Westminster Primary Care Trust who had not responded to at least two screening invitations.

Self-sample HPV test kits were sent to half the women, while the other half were sent another invitation for cervical screening.

Around 10 per cent of women in the first group responded to receiving kits. This was made up of 96 women (6.4 per cent) doing the self-sample and in addition, 57 (3.8 per cent) booking an appointment to be screened in the usual way.

In the other group, 68 women (4.5 per cent) went for a smear test after receiving a third invitation.

Dr Anne Szarewski, lead author of the study and a Cancer Research UK cervical cancer expert, said: “Women who don’t go for cervical screening face a higher risk of cervical cancer so it’s important to encourage these women to take part. HPV self-sampling could be an effective way of getting women to be screened.

“Home testing for HPV is as accurate as samples taken by doctors and can help address some of the reasons, like finding time or being embarrassed, that women often give as reasons for not attending screening.”

Screening for cervical cancer – the most common form of cancer in women under 35 – can prevent cases of the disease.

But over the last ten years the coverage rate – the proportion of women aged 25-64 in England who have had a cervical screening test at least once in the previous five years – has been edging lower and is now 78.9 per cent, just below the government’s target of 80 per cent.

A one per cent fall in the coverage rate accounts for around 165,000 women.

The authors say the study should be repeated in other areas to find out if the level of response seen in Westminster is likely to be representative of the rest of the country.

In the HPV home test group eight women tested positive for HPV - two had high grade stages of abnormal cells and one had an invasive cancer. Dr Szarewski said this showed that self-sampling had the potential to pick up even more women with abnormalities.

While most women infected with HPV do not develop cervical cancer, the virus is the major cause of the disease.

Sara Hiom, director of health information at Cancer Research UK, said: “Although we saw a surge in the number of women going for smear tests immediately after the sad experience of Jade Goody, we know a significant proportion of women are not going for screening.

“Cervical cancer is one of the few cancers that can be prevented through screening by picking up early changes in the cells which can lead to the disease. So finding a way to screen women who do not go for smear tests could be very valuable.

“HPV home tests could help overcome some of the barriers women face, especially those from deprived backgrounds or ethnic minorities where cultural barriers play a role.

“More research is needed to see if the response to self-sampling around the country would be generally higher but this study suggests it may have the potential to prevent even more cases of cervical cancer along with the current screening programme.”

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References

**Szarewski, A et al., HPV self-sampling as an alternative in non-attenders for cervical screening – a randomised controlled trial, British Journal of Cancer (2011) DOI:10.1038/bjc.2011.48

Notes to Editor

*funded by a National Institute for Health Research (NIHR) Research for Patient Benefit (RfPB) Programme grant