Behind the Headlines: Should women start using a self-sampling smear test?

A self-sampling smear test could increase cervical cancer checks among women who are too busy or anxious to attend regular screenings, according to news reports.

Light micrograph showing grade 2 cervical cancer
Light micrograph showing grade 2 cervical cancer

Online pharmacy DrThom has launched a home smear kit in the UK to test for HPV-infected cervical cells, a major cause of cervical cancer.

The launch coincided with the release of a Dutch study that examined the effectiveness of self-sampling cervical smear test kits as a screening method.

Researchers concluded that self-sampling is an effective method for women who do not attend regular screening programmes.

What did the study show?
Non-attendance to smear tests remains a major concern in the effectiveness of current cervical screening programmes, researchers noted.

About 15 per cent of women in the UK miss appointments because they are too busy, according to Cancer Research UK. Studies have shown non-attendees have increased risk of cervical cancer.

In the research, Murat Gok and colleagues from the University Medical Centre, Amsterdam, studied 28,073 women who had declined two previous invitations for regular cervical screening.

They were randomly assigned to receive either a self-sampling lavage device, or a third recall for conventional cytology as the control group. Outcomes were defined as attendance rate and yield of cervical intraepithelial neoplasma (CIN), the precursor to cervical cancer.

Among those allocated to the self-sampling device, 27 per cent returned the kits. This compared with just 17 per cent who visited their GP for cervical cytology from the recall control group. Researchers also found CIN yields were identical in the two groups.

The authors concluded that it is 'feasible and effective' to offer self-sampling to women who do not attend regular screening and it should boost coverage and detection of precancerous CIN.

Should guidance change?
Cancer Research UK said it backs research into self-sampling. Professor Stephen Duffy, Cancer Research UK's professor of cancer screening at Queen Mary, University of London, said: 'While it is important for women to attend their cervical screening appointments, some find it difficult to do so for cultural or other reasons. For these women, self-sampling for HPV may be an option.'

But the charity went on to say it could not support the DrThom test because of 'a lack of published data on how effective this would be'.

It is not clear what proportion of women under 25 would test positive for HPV, but this could exceed 15 per cent, the charity said.

Professor Peter Sasieni, a Cancer Research UK epidemi-ologist, said: 'In these cases it is not clear what back-up would be provided, who would pay if DrThom recommended colposcopy, or whether GPs would know enough about the test to counsel patients.'

DrThom said its test looks for evidence of HPV integration into the genetic material of cervical cells, a key indicator of cancer risk, and is as accurate as conventional screening.

Medical director Dr Thomas Van Every said: 'This is a very useful tool for general practice, whose patients are not having smears at all.'

Informing patients
  • Women who do not attend cervical smear tests are at higher risk of cervical cancer.
  • Research suggests home kits could increase detection rates of precancerous cells in those who do not attend screenings.
  • Cancer Research UK says for these women, self-sampling for HPV may be an option.

 

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