New research from University of Manchester experts suggests that introducing a UK-wide self-sampling programme alongside existing ‘smear tests’ could help to remove most of the current barriers to cervical screening.
In an article published by Policy@Manchester, Stephanie Gillibrand, Caroline Sanders, Emma Crosbie and Jennifer Davies argue that a national rollout of self-sampling methods including a novel urine test could also “fulfil the promise of successive governments and aid in addressing health inequities for under-served groups.”
The authors highlight that cervical cancer accounts for 2% of new cancer cases in women in the UK, affecting over 3,000 people each year, with those from more socioeconomically deprived areas particularly affected.
And they remind readers that cervical screening – commonly known as the ‘smear test’, carried out using a speculum – is key to detecting and treating the disease at preinvasive stages before the development of cervical cancer, when outcomes for patients are most positive.
But they add: “While the incidence of cervical cancer in the UK has fallen since the 1990s, so too has screening coverage, particularly since the COVID-19 pandemic.”
Against this background, the University of Manchester academics set out to explore the barriers to screening uptake and how the introduction of self-sampling methods – which have similar test accuracy to routine cervical screening – could help to overcome these barriers.
Working with 46 participants from across Greater Manchester, Gillibrand, Sanders, Crosbie and Davies – alongside colleagues from the University of Manchester – investigated attitudes to, and experiences of, current cervical screening.
“Many participants described negative past experiences as barriers to attending future screening appointments, with pain and discomfort a common point raised by participants of all backgrounds,” they write. “Other participants, especially those from ethnic minority backgrounds and those with mental health conditions, highlighted a lack of empathy or feeling of being rushed by the healthcare professionals (HCPs) carrying out the screening.”
They add: “The speculum itself was a significant element of participants’ discomfort and often formed part of their reluctance to attend screening appointments.”
The authors also make clear that “not all experiences reported by participants were negative” with examples of good practice referred to, “particularly where HCPs helped them to feel comfortable and communicated well throughout the procedure.”
From their research, Gillibrand, Sanders, Crosbie and Davies explain in the article that self-sampling alternatives to cervical screening – such as a vaginal swab or urine sampling – were welcomed by all participant groups, “being seen as more accessible than the traditional speculum method, as well as less invasive and less stressful.”
They write: “These methods also increased feelings of control and autonomy. Being able to do screening in their own homes was highlighted as a key benefit, with participants generally seeing it as more practical and convenient.” They add: “The removal of the need for the speculum was particularly welcome among participants, and ultimately, participants felt that self-sampling methods gave patients a choice in which method was most suitable for them.”
Concluding their piece, the University of Manchester academics describe cervical screening as “an essential tool in the armoury to eliminate cervical cancer” that ensures “the best outcomes for the patients and lowering the cost to health services.”
They continue: “It is therefore vital that screening is made as accessible as possible, to ensure the greatest burden of disease does not fall on individuals and communities who already face additional barriers to accessing healthcare. A national rollout of self-sampling methods would help fulfil the promise of successive governments, and aid in addressing health inequities for under-served groups.”
‘Cervical cancer prevention: ensuring equity throughout the screening process,’ by Stephanie Gillibrand, Caroline Sanders, Emma Crosbie and Jennifer Davies is available to read on the Policy@Manchester website.
