‘Lives will be lost’ over cervical smear delays

Self-swabbing is urgently needed in order to save lives after 50,000 cervical smears were missed during lockdown, experts say.

Top GP Dr Ra¯ wiri Jansen called for home testing to be implemented now and feared ‘‘we will have lives lost’’ from the backlog of diagnosis.

Cervical cancer is caused by some strains of the human papillomavirus (HPV). About 160 women develop cervical cancer each year and about 50 die from it.

The move from smear tests to better HPV-based screening, which women can do at home, was first promised in 2017 but won’t be considered for funding until later this year. Attempts to get the programme funded in 2018, 2019 and again in 2020 were rejected.

Women will have to wait at least two years for cervical screening improvements.

The delay was ‘‘ridiculous’’, said Dr Jane MacDonald, senior research fellow at Victoria University of Wellington’s Centre for Women’s Health Research.

She said it would leave New Zealand’s screening programme ‘‘years behind’’ comparable countries, including Australia.

HPV-based screening involves a swab being taken from inside the vagina. It is less invasive and uncomfortable than smear tests, where a doctor uses a speculum to check for abnormal cells in the cervix.

‘‘It’s going to be two years before it’s up and running,’’ she said. ‘‘That means women still won’t have access to HPV swabs in New Zealand [once the programme is given funding]. We will be five years behind Australia. It is ridiculous for a country of this size.’’

She said cervical cancer could be eliminated ‘‘with vaccination and detection’’. About 50,000 fewer women were screened for cervical cancer at the end of May 2020 after the programme was

paused during lockdown, but by December about 22,000 fewer women were screened. Jansen said Ma¯ ori and Pacific women would be impacted by the lockdown delays.

‘‘We won’t get them back,’’ Jansen said of the missed smears. ‘‘Our primary care system has never achieved the target for cervical smears. Our primary care system delivers inequitably for Ma¯ ori and Pacific women.’’

Research shows 34 per cent of Ma¯ ori women don’t get regular screening, compared with 21 per cent of Pa¯ keha¯ women. As a result, Ma¯ ori women die at two-and-a-half times the rate of nonMa¯ori. Whakama¯ (shame), fear about what the procedure entails and other cultural barriers play a role.

Cervical smears surged when Cabinet Minister Kiritapu Allan announced she would step down from ministerial duties after being diagnosed with stage 3 cervical cancer last month. Jansen applauded Allen for speaking out but expected the uptake to be short-lived and called for ‘‘systemic change’’.

Family Planning chief executive Jackie Edmond agreed. ‘‘It probably won’t last, unfortunately. We have short memories.’’ The organisation usually does about 16,000 smears a year, but did less than 10,000 last year.

Still, if only 100 women were tested as a result of Allan’s announcement it would make a difference, she said.

Ministry of Health spokeswoman Emily Barrett said it would take two years to include the new screening test, change the clinical pathway and develop the supporting systems.

‘‘We will be five years behind Australia. It is ridiculous for a country of this size.’’

Dr Jane MacDonald

Victoria University of Wellington’s Centre for Women’s Health Research.