Are homemade smears the future of cervical cancer prevention?

Regular cervical screening (also called Pap smears) is vital for cancer prevention. Yet almost a third of women in England have not taken their most recent test when it is offered to them, according to the latest report. NHS Cervical Screening Survey.

Being too busy to attend an appointment, or having difficulty making one, are among the reasons given, but people who find the exam anxiety-provoking, painful or embarrassing are often a deterrent.

In recent years, home self-tests have been developed and some large trials have been carried out recently with positive results. But home tests are not yet available on the NHS.

There are currently a few home HPV test kits available for private sale, so could they offer a solution? We asked experts to help you decide what’s right for you.

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Why should you test for HPV?

HPV (human papillomavirus) is a common virus that most people get at some point in their lives, and in most cases the immune system fights it off.

However, some high-risk HPV strains are of greater concern as they are responsible for almost all cases of cervical cancer, which is the 14th most common cancer among women in the UK and, according to Cancer Research , the sixth leading cause of cancer. death for the same group.

It can be avoided through regular screening, and all women should be offered a NHS screening test every three years from the age of 25 and every five years between the ages of 50 and 64.

Indeed, these are the ages when you are likely to be most at risk. However, if at any time you experience worrying symptoms, you should see your GP – don’t wait for a screening test.

Home cervical screening: a game changer?

Research commissioned by Healthwatch shows that women reluctant to have a smear are in favor of the idea of home self-tests and a YouScreen/NHS trial in the UK, released in July 2024, found that offering women self-sampling HPV tests significantly improved screening rates, leading experts to say that these DIY HPV kits could “change the deal.”

When you attend an in-person cervical screening, the healthcare professional uses a speculum to widen the vagina before taking a sample using a long stick shaped like a cotton swab, but with an at-home test, you do not need to use a speculum.

After collecting your own sample using a long cotton swab or swab, you either send it for laboratory testing or, in some cases, expect a result at home within 15 minutes (a bit like a Covid test).

There is another variant in development, the Papcupsupported by the Cancer Research innovation fund. This uses a menstrual blood sample and means you don’t have to insert anything into your vagina. But it is still far from being available.

According to the YouScreen study, HPV self-test kits have already been successfully rolled out in countries including Denmark, Australia and Switzerland, but they have not yet been rolled out in the NHS.

There are, however, some tests available to purchase privately, usually costing between £50 and £70.

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Does a home HPV test mean I can avoid cervical cancer screening?

While this is a promising development for those hesitant to get tested otherwise, experts we spoke to warned against abandoning in-person NHS screening in favor of private testing.

An NHS cervical screening appointment doesn’t just involve taking a sample – it also gives the healthcare professional the chance to ask you about any symptoms you might be experiencing and check your vulva for any worrying sign.

Additionally, if high-risk HPV is detected, this will initiate an entire care pathway to ensure you get additional testing and treatment if necessary. Your sample would be tested to detect cell changes that could cause cancer (a Pap test).

Depending on your results, you may then be invited to the hospital for a colposcopy and possibly a biopsy to take a closer look and decide next steps.

Home cervical screening shows promise but has drawbacks

While the YouScreen trial is encouraging, experts say evidence is not currently available to support self-tests replacing smears administered by trained healthcare professionals, and are particularly cautious about private offerings.

Professor Kamila Hawthorne, president of the Royal College of GPs, told Which? : “We would not advise women to use commercial self-test kits as a replacement for cervical screening provided by the NHS.

“Paid tests don’t always contain all the information you need, and if you use them you may not be able to get follow-up care through the NHS” (without starting over and getting a cervical screening test of the NHS) ).

Dr Rachel Orritt of Cancer Research UK says research is underway to determine whether cervical cancer self-testing is accurate before it is considered part of the national programme, and added: “We do not encourage people to get screened for cancer outside the country. NHS National Screening Program.

However, given the link between high-risk HPV and changes in cervical cells that can lead to cancer, some experts say HPV self-testing has a role to play in helping women take proactive steps for their health, especially when lack of time, cultural factors, obstacles or embarrassments can get in the way.

Professor Claire Anderson, President of the Royal Pharmaceutical Society, said: “These tests have become a key tool in increasing access to cervical cancer screening. While this option will not replace valuable interaction with a healthcare professional, it is a less invasive alternative and research shows that 99% of people are able to do this accurately at home.

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Tips for a More Comfortable Cervical Screening Experience

For now, it’s worth knowing what you can do to make an in-person test more comfortable. Here are some tips:

Be prepared. Before attending your cervical screening, educate yourself about the process so you know what to expect. A good start that’s it NHS video guide to cervical screening.
Explain how you feel up front. You can specifically ask a healthcare provider if this makes you more comfortable and tell the person doing your test if you feel anxious or have had pain problems before. They can do a number of things to help you.
Ask for a different size speculum. This instrument is placed inside your vagina to open it and provide easier access to the cervix. If you’re not comfortable, ask your healthcare professional about using a smaller size, more lubricant, or trying a different position. They should work with you to make the session comfortable, but if you feel pain, you can stop at any time.
Wear clothes in which you feel comfortable. And by that we mean ones that help you cover up so you only have to take off your underwear during the drug test — a dress or skirt may be better than pants or a jumpsuit. You will also receive a sheet to cover.
Ask to go to a specialized clinic. A cervical screening can be carried out at your GP practice, but there are other options if this doesn’t work for you. Your GP may refer you to the gynecology clinic at your local hospital, which may, for example, offer a wider range of speculum sizes.

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HPV Self-Test Kits: What’s Available Now?

If you are considering using an HPV self-test kit, here are some commercial kits currently available. Please note we have not tested these products and they are not recommendations.

Any test you purchase should give clear guidance on what your results mean and next steps. Keep in mind that if you get a positive result you will probably need to go to your NHS GP and book a smear test.

The Doctors Laboratory HPV Home Test Kit (from £55)

Available from Asda, Superdrug Online Doctor

Type of test: Vaginal swab to send to the laboratory

How it works: You use a cotton swab to collect a sample of vaginal cells to send to the laboratory in a prepaid envelope. Results will be available within seven days of the sample arriving at the laboratory.

What you need to know: Information on the Superdrug website states that this HPV test is different to that used by the NHS and that “you may need further testing by the NHS” if problems are found.

It also warns: “HPV testing does not replace the need for regular smear tests. »

Daye HPV Test (£69)

Available from Day

Type of test: Buffer

How it works: This “non-invasive at-home swab test kit” can detect HPV16, HPV 18 and 12 other high-risk strains of HPV.

The Daye “diagnostic tampon” – complete with applicator – is worn in the vagina for 20 minutes before being removed and sent to Daye for analysis.

Results come back within five to 10 days with a detailed report. If you test positive for an STI, you will receive a free consultation with a sexual health nurse.