Cervical Screening Test Self-Collection

Did you know that you can take your own cervical screening sample? If you’ve been avoiding a test, this information could be life-saving!

An extract from an article by Dr Elina Safro, Chair of the Education Subcommittee of the Australasian Menopause Society, to inform GP’s.

National Cervical Screening Program (NCSP) has paved the way for Australia to become the first country in the world to eliminate cervical cancer within the next decade or two (1). However, the ongoing engagement in the program remains low, with only 56% of eligible participants between the ages of 25-74 screening as frequently as recommended. This means that almost 44% of eligible Australian women have either never screened or are lapsed screeners (2).

To improve participation in the NCSP, from July 1 2022 self-collection of vaginal samples has been introduced as an option for all eligible women, along with the clinician-collected option using a speculum to visualize the cervix. Self-collection could help to overcome common barriers to participation, boosting the engagement with the recommended 5-yearly screening for low-risk Cervical Screening Test (CST) results. The self-collected CST has been shown to be no less accurate than clinician-collected sampling in detecting oncogenic HPV [Human Papillomavirus] when using PCR testing (3).

The universal self-collection option can be a game-changer for menopausal women. For this group, common barriers to screening include fear of discomfort with the use of speculum due to vaginal dryness; hip and spine joint pain making genital examination challenging; and fear of embarrassment frequently associated with intimate examination.

Women choosing the self-collection option should be advised that, in some cases, they will need to return for a clinician-collected sample involving speculum examination to visualize the transformation zone. Routine inspection of vulva and vagina during cervical screening is not recommended, unless concerning symptoms are present including pain, bleeding, itching or PV discharge. All women aged 25-74 are eligible for self-collection, including those with total hysterectomy with no record of cervical pathology and an unknown cervical screening history.

The following presentations are not eligible for self-collection:

• Postcoital bleeding [ie. bleeding after sex] (requires a co-test);
• Post-total hysterectomy with a history of HSIL [Higher grade cell abnormality];
• Undergoing a test of cure following treatment for HSIL or a glandular abnormality (including adenocarcinoma in-situ); and
• DES exposed in utero (daughters of women who used DES during pregnancy).

Practical points for self-collected CST samples:

• They must be ordered by a healthcare professional, preferably in a clinic setting. However, if the healthcare professional believes it is appropriate, they can be collected in another setting. This means that cervical screening can potentially be offered via Telehealth, given that samples can remain stable for up to 28 days after collection prior to analysis;
• There is no requirement to observe the patient self-collecting the sample. Self-collection can occur in a bathroom or behind a curtain in a clinic room;
• Assistance can be given if the patient has difficulties with self-collection, meaning that the clinician can collect a sample without a speculum. This still qualifies as self-collection.
• Unsatisfactory reports for self-collected samples are rare. In the case of an unsatisfactory report, a self-collected CST can be repeated in 6 weeks.

Importantly, the recommendations for the following groups are different due to their higher risk of cervical cancer; they should be referred for colposcopy [detailed examination of the cervix by a specialist, requiring a speculum] if HPV (any type) is detected at 12 months as they may be at higher risk of a high-grade abnormality:

1. Women aged 50 years or older.
2. Women who are two or more years overdue for screening at the time of the initial screen.
3. Women who identify as Aboriginal and/or Torres Strait Islander.

[For more information about how to arrange and conduct self-collected cervical screening tests, check out this excellent resource from the Cancer Council Victoria, or this from the Federal Government’s Department of Health and Aged Care]

References

• Australian Institute of Health and Welfare 2019. Analysis of cervical cancer and abnormality outcomes in an era of cervical screening and HPV vaccination in Australia. Cancer series no. 126. Cat. no. CAN 129. Canberra: AIHW
• Australian Institute of Health and Welfare 2019. Cervical screening in Australia 2019. Cancer series no. 123. Cat. no. CAN 124. Canberra: AIHW. p.67;72.

Source content created July 2022

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