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Self-collection HPV testing in remote Australia
Testing for HPV using self-collection can increase our ability to eradicate cervical cancer by 2035, writes Carina Brown RM, Clinical Workforce Educator, SHINE SA.
In 2022, Cancer Australia estimates 942 new cases of cervical cancer will be diagnosed in Australia. Cervical cancer is twice as prevalent in Australian Aboriginal women and they are three times more likely to die from the disease than their non-Indigenous counterparts. Also, more cases will be diagnosed in rural and remote areas in Australia (Cancer Australia, 2022).
Currently, only 63 per cent of eligible people in Australia are up to date with the cervical screening schedule recommended by the National Cervical Screening Program (Cancer Council, 2022). In response to targeting underscreened groups, the Australian Government introduced a partial update to the cervical screening guidelines resulting in increased eligibility of self-collection for HPV testing. This will not only result in less invasive testing but provide a way forward to increasing testing in under-screened groups, some of whom reside in regional and remote Australia (Cancer Council Australia, 2022).
Up until recently, attending a health service for cervical screening meant an invasive clinician-led procedure which could be uncomfortable and difficult for people with a trauma history. A recent study found embarrassment, fear of results, lack of time and lack of female practitioners as reasons for lack of participation (Nagendiram A et al 2019). Other studies cite histories of sexual abuse and trauma as a barrier (Cadman L, 2012).
Couple these research findings with the limited availability of appointments in GP practices and fly in/fly out clinics in remote regions, and it is easy to see how clinician-collected cervical screening tests get pushed to the backburner, resulting in under-screened populations.
Offering self-collection, which is controlled by the patient, could increase testing rates and is seen as a game changer in the fight to eliminate cervical cancer in Australia by 2035 (ACPCC, 2022).
These new guidelines do not replace the need for formal cervical screening training offered by sexual health teaching organisations throughout Australia. To offer cervical screening to patients, clinicians should first complete cervical screening training which will be informed by the National Cervical Screening Program guidelines (Cancer Council Australia, 2022).
Undertaking the training will alert clinicians to the various criteria for who should be offered self-collection screening.
Mainly, people who do not have symptoms of concern between the ages of 25 – 74 who have ever been sexually active can be offered self-collection test. Examples of symptoms of concern are abnormal, post-menopausal and intermenstrual bleeding as well as pain or abnormal discharge. These people would not qualify for self-collection but instead would be offered a clinician-collected sample as further investigations are required and a co-test (cytology) should be ordered to detect any cellular changes. Co-tests cannot be ordered from a self-collected swab and must be ordered through a clinician-collected cervical sample.
One of the common concerns with the selfcollection method is whether the testing is as reliable and accurate as clinician-collected samples. A recent meta-analysis found that the sensitivity and specificity of HPV testing to detect CIN2+ in self-collected samples were similar to those for clinician-collected samples when using validated PCR-based HPV assays (Cancer Council, 2022).
Self-collection HPV tests are obtained using a flocked swab which is highly resilient and can withstand very hot and cold temperatures, as well as lasting for up to 28 days once the swab is collected.
This robust feature of the test is what is most attractive to rural and remote clinicians who are logistically isolated from testing facilities.
The resilience of the swab also allows practitioners in rural and remote areas to test opportunistically in their clinics, rather than waiting for dedicated clinics, which are often set up on a fortnightly basis and are booked solidly with more immediate issues. This will hopefully result in the reduction of cervical cancer cases in rural and remote Australia and the World Health Organisation’s goal to eradicate cervical cancer by 2035 will hopefully be met.
Australian Centre for the Prevention of Cervical Cancer (2022), Let’s Eliminate Cervical Cancer by 2035, Australia’s National Cervical Cancer Elimination Strategy | acpcc.org.au, cited 18/9/22
The Australian Government (2022), Cancer Australia, Cervical cancer in Australia statistics | Cancer Australia, cited 18/9/22.
Cancer Council Australia (2022), National Cervical Screening Program, Cervical cancer screening | Cancer Council, cited 18/9/22.
Cancer Council (2022) Updated guidelines prepare health professionals for cervical screening ‘game-changer’ | Cancer Council, cited 18/9/22
Cancer Council, (2022) Self-collected vaginal samples | Cancer Council. Cited 18/9/22
Cadman L, Waller J, Ashdown-Barr L, et al Barriers to cervical screening in women who have experienced sexual abuse: an exploratory study Journal of Family Planning and Reproductive Health Care 2012;38:214 – 220.
Nagendiram A, Bougher H, Banks J, Hall L, Heal C. Australian women’s self-perceived barriers to participation in cervical cancer screening: A systematic review. Health Promot J Austr. 2020 Sep;31(3):343 – 353. doi: 10.1002/hpja.280. Epub 2019 Aug 7. PMID: 31353682. https://pubmed. ncbi.nlm.nih.gov/31353682/
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