Cervical screening self-collection off to slow start

From 1 July, the National Cervical Screening Program (NCSP) expanded screening processes to include self-collection for all eligible women and people born with a cervix.
 
Hailed as a ‘gamechanger’ by GP, women’s health expert and National Cervical Screening Program Self-Collection Implementation Committee member Dr Lara Roeske, the self-collection process is aimed at boosting screening participation.
 
But the results of a recent newsGP weekly poll suggest that uptake of self-collection remains low, with the majority (67%) of respondents reporting that none of their eligible patients had taken up the self-collection option.
 
A further 20% reported that less than half of all eligible patients had participated, while just 8% said the majority had opted in.
 
Dr Roeske said while she is pleased to see some patients are already making use of expanded access to self-collection, there is still much room for improvement.
 
‘We really want to see many more people taking it up,’ she said.
 
‘We need to address the barriers limiting uptake, because the self-collection option is now available to everyone who needs cervical cancer screening, so we should see more widespread use of it.’
 
In a recent newsGP article in the lead up to the 1 July expansion of self-collection, Dr Roeske outlined practical information for GPs as well as barriers to uptake.
 
This week, in response to the newsGP poll results, Dr Roeske is calling for improved public-facing campaigns and communications to encourage people to see their GP about the option of self-collection.
 
‘Self-collection is being held back by the lack of public awareness that this option is now available to everyone who needs cervical cancer screening,’ she said.
 
‘There hasn’t been a big public-facing campaign to encourage people to see their GP and ask about self-collection, and we sorely need this.
 
‘We also need to raise awareness that the self-collection test is just as accurate a test as the traditional clinical-collected sample.
 
‘Self-collection addresses many of the barriers to traditional screening, allowing people control and dignity – it is a real gamechanger in our fight against cervical cancer by increasing equitable access to screening for eligible Australians.’
 
As part of a Women’s Health Week partnership with the RACGP, Jean Hailes has released its 2022 National Women’s Health Survey, conducted in March–May 2022 with over 14,000 respondents, with a focus on healthcare during COVID-19.
 
The survey results, referring to women and gender-diverse people as ‘all women’, reveals that many had missed appointments due to the pandemic.
 
One in five women said they had missed a GP health check, with 8% reporting they had missed either a mammogram to check for breast cancer or a cervical cancer screening.
 
RACGP President Adjunct Professor Karen Price says that Women’s Health Week is a reminder for women to ‘get back on track’ with health checks and ask their GP about the new self-collection option for cervical cancer screening.
 
‘The Jean Hailes survey shows women have continued to put health checks on the back burner during the pandemic,’ Professor Price said. 
 
‘This is very concerning because it leads to delayed diagnosis and worsening illness. And GPs across Australia are seeing this, indeed our entire health system is grappling to deal with the backlog of care from people putting off appointments and screening due to COVID-19. 
 
‘It’s critical that we get screening back on track in Australia. And this includes everything from breast screens to heart health, mental health assessments and osteoporosis prevention, as well as supporting the updated self-collection process for cervical cancer screening in our practices.’ 
 
Speaking to newsGP, Dr Roeske said there are ‘several well understood barriers’ for GPs in regard to the uptake of self-collection, so it is important to also support practitioners in offering the self-collection option and instilling confidence.
 
‘Some GPs may be confused about their role in supporting self-collection in their practice,’ she said.
 
‘This includes identifying eligible patients, routinely offering the choice to self-collect, and discussing the benefits of self-collection with patients.
 
‘Also, GPs may not trust the test; they may incorrectly believe it is not as accurate or effective as a clinician-collected sample for cervical screening.
 
‘GPs have a central role in the follow-up management of both negative and positive results and explaining how to take the test, and in some cases taking the test for eligible people with [for example] poor vision, significant tremor, or restricted mobility.’


Dr Lara Roeske is a strong advocate for uptake of self-collection for cervical cancer screening.

With the NCSP having a number of recent updates on screening processes, Dr Roeske said there may still be some confusion on processes and eligibility among GPs.
 
‘When the renewed NCSP was first introduced in 2017, there was some delay before GPs could also support the self-collection option as part of the renewed program,’ she said.
 
‘This staggered start was confusing for some GPs, and with so many changes, [such as] HPV-based testing replacing cytology, a five-year screening interval instead of a two-year interval, and a later age to start screening, self-collection may have been just too difficult to incorporate alongside the other changes in busy general practices.
 
‘During 2017–21 there were significant limitations with respect to the eligibility criteria for self-collection, including a start age of 30, and for people who were at least two years overdue for screening or never screened.’
 
In addition, Dr Roeske highlights that there continues to be limited laboratory capacity and support for general practice, with currently only 10 laboratories in Australia accredited to accurately process self-collected samples.
 
She is calling for better support in the self-collection process and hopes that Women’s Health Week will help to further raise awareness of the importance of cervical screening.
 
‘Self-collection is a great step forward for medicine, women and people with a cervix,’ Dr Roeske said.
 
‘If we can raise public awareness and ensure support for general practice to boost uptake, it can, and will save lives.
 
‘GPs have a crucial role in determining together with their patient when self-collection is a good choice for them and then supporting them to take the test, and I urge patients who are eligible to talk to their GP about it.’
 
Other results from the Jean Hailes survey reveal that 43% of women reported their physical health had declined since the pandemic began, and only 35% of women rated their health as ‘very good’ or ‘excellent’, which is a decrease from 56% in 2017–18.

Health inequities were also highlighted, with 44% of women reporting they could not afford to see a doctor or other health professional when they needed it.
 
Women from non-English speaking backgrounds made up 70% of this figure, followed by women with a disability (62%) and Aboriginal and/or Torres Strait Islander women (53%).
 
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