Self-collection reaching under-screened populations

Morgan Liotta

28/03/2024 2:42:55 PM

Uptake of the cervical cancer screening option has been particularly high among Aboriginal and Torres Strait Islander people in the NT.

Female GP speaking to older female patient.
A ‘more culturally appropriate screening option’ has led to a recent increase in cervical screening self-collection uptake in the Northern Territory.

Self-collection rates for cervical cancer screening continue to grow, with the latest available data showing more than 315,000 Australian women and people with a cervix have used the option.
Criteria was expanded for the National Cervical Screening Program (NCSP) from July 2022, which allowed self-collection of samples to be offered to all eligible screeners – women and people with a cervix aged 25–74.
According to the NCSP data, in the past year, one in three people who had never screened for cervical cancer and 40% of those overdue for screening took up the self-collection option. Around 27% of all screening tests are now done this way, demonstrating a large increase from 1% prior to the 2022 expansion.  

One population with a ‘big success story’ of increased self-collection testing rates is Aboriginal and Torres Strait Islander women in the Northern Territory, says Assistant Minister for Health and Aged Care Ged Kearney.
‘[The] do-it-yourself test is saving lives – we’re seeing women who would otherwise not be screened, take the test,’ she said.
‘This increase … puts us closer to closing the gap on First Nations testing rates so we can drive down the rate of cervical cancer in these communities.’
A consistent increase in self-collection uptake since criteria expanded is demonstrated in the most up-to-date figures, from 10% in the third quarter of 2022 to 27% in the fourth quarter of 2023.
This increase was seen across all jurisdictions, age groups, quintiles and remoteness areas, but was highest in 70–74-year-olds (34%), in the Northern Territory (47%), the most disadvantaged quintiles (29%) and in very remote areas (51%).
Dr Simone Liddy is an Aboriginal GP in the Northern Territory, working part-time at Danila Dilba Health Service. She has seen first-hand the difference the expanded criteria has contributed to the rise in self-collection rates among her patients.
‘The self-collection changes have provided Aboriginal and Torres Strait women a more culturally appropriate screening option,’ Dr Liddy told newsGP.
‘This has made it easier and more acceptable for women to participate in this simple screening test.
‘Many of my female Aboriginal clients have presented to the clinic for management of other medical problems, and not solely for a cervical screening test. Some women have children with them during consults, so time constraints and privacy were barriers when the test was clinician-collected.
‘Self-collected tests have become more acceptable to perform opportunistically as it is fast, easy, and more comfortable and private for clients.’
Dr Liddy has also observed an increase in male GPs offering the screening test in the Aboriginal healthcare setting, highlighting the growing awareness and acceptance of self-collection.
The NCSP data shows that during 2023, almost 19% of self-collected tests were from people who transitioned from clinician-collected, marking a significant increase from 4% in 2022.
The ‘consistent increase’ in self-collection uptake after the 2022 expansion, especially in older people and those who are under-screened, indicates it is ‘overcoming barriers and improving access to screening in the traditionally hard to reach groups’, the NCSP report states.
These figures support initial recommendations when the program was first expanded, to target under-screened people to boost participation rates among specific groups who the RACGP flagged would benefit from self-collection, specifically:

  • people who have experienced sexual violence and trauma
  • Aboriginal and Torres Strait Islander people
  • LGBTQIA+ people
  • people from culturally and linguistically diverse and refugee communities
  • people living with disability.
Supporting people to consider and use the cervical cancer screening option is routine practice for GPs as part of their role in preventive health, according to Dr Liddy.
‘A GP’s role is to offer the test to anyone who is eligible that walks through our doors,’ she said.
‘It is our responsibility to educate and increase awareness on how safe, easy and effective the test is in the prevention of cervical cancer.’
The latest NCSP data is ‘a reminder’ that Australia is on track to be the first country in the world to eliminate cervical cancer by 2035, Minister Kearney said, through public health strategies such as the self-collection expansion, the Federal Government’s National Strategy for the Elimination of Cervical Cancer and a $48.2 million investment to support implementation.
Noting the importance of providing tailored and accessible healthcare, Minister Kearney said the self-collection option is meeting that need and reaching under-screened populations.
‘These tests are … more private, culturally safe and available to women in remote areas,’ she said.
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Dr Sally Dunbar   29/03/2024 7:16:13 PM

Positive news.
But now we need appropriate colposcopy referral pathways for women who require further assessment and who are extremely fearful, traumatised or for whom the process is culturally unacceptable. A start would be a clinic with female-only staff and a trauma- informed approach, ideally also with ATSI and other culturally diverse support people available when needed.