Self-testing could save lives

A Ministry of Health-funded study led by Victoria University of Wellington’s Te Ta¯tai Hauora o Hine Centre for Women’s Health Research has confirmed the lifesaving potential for Ma¯ori women of selftesting for cervical cancer.

Cervical cancer is the second leading cause of cancer death for Ma¯ori women aged 25-44, and Ma¯ori women are more than twice as likely as New Zealand European women to be diagnosed with, and three times more likely to die from the disease.

Most cervical cancers occur in women who have either not undergone screening or had infrequent screening — 34 per cent of Ma¯ori women, compared with 21 per cent of New Zealand European women, do not attend regular screening.

The study looked at whether Ma¯ori women who had not been screened regularly would use a new self-test looking for the cancer-causing human papilloma virus (HPV). HPV screening is more effective at preventing cervical cancer and its associated premature death than the current smear test, new technology enabling women to screen themselves.

The study found the most frequently cited barrier to current screening was whakama¯ — embarrassment, shyness, and/or reticence. A lack of time and fear of discomfort or pain were also leading barriers.

Seventy-five per cent of study participants said they would be likely or very likely to self-test, 90 per cent being likely or very likely to attend a follow-up if they tested positive.

The findings are informing the ongoing development of the Ministry of Health’s national cervical screening programme, with self-testing being explored as an option for making screening more accessible once HPV primary screening is introduced.

International HPV self-testing acceptability studies of other indigenous and ethnic minority women had similar findings.

“Self-collected vaginal specimens can be used for HPV screening, and recent evidence suggests they provide sensitivity and specificity equal to cliniciancollected specimens for detecting highrisk HPV types. We need to implement this new cancer prevention screen as soon as possible to save lives,” said Anna Adcock, Research Fellow at Te Ta¯tai Hauora o Hine and co-lead of the study.

“Hui participant responses to the idea were generally very positive, women using terms such as ‘easier,’ ‘more comfortable,’ ‘less intrusive’ and ‘brilliant’. Our findings suggest that, implemented in a flexible and culturally sensitive way, HPV self-testing could be very acceptable for Ma¯ori women who find current screening unacceptable,” she added.

Findings have also informed Te Ta¯tai Hauora o Hine’s Health Research Council of New Zealand-funded randomised controlled trial under way in Northland, aimed at establishing if the offer of selftesting would increase the rate of screening uptake.

“The trial has been successful so far, and the offer has been taken up by about 45 per cent of eligible women,” Ms Adcock said.