A step towards improving cervical screening uptake

We thank Landy and colleagues for their recent article on non-speculum clinician-taken samples for human papillomavirus (HPV) testing.¹ This article further validates an approach that may improve participation in cervical screening and coincides with the introduction of an option for a self-collected vaginal sample as part of Australia’s National Cervical Screening Program. This change, which came in on 1 July this year, enables women to self-collect a vaginal sample within a general practice to screen for 14 high-risk HPV types.

However, rates of cervical screening are lower in Australia compared with the UK. For example, between 2018 and 2020, the estimated 3-year participation rate was 56%, much lower than the 68.9% of women aged 25 to 49 years and 75.0% of women aged 50 to 64 years screened in the UK.^2,3

This change acts to increase participation in under-screened groups. In Australia, rates of under-screening are greatest for those aged 70–74 years (27% vs 61% in 45–49-year-olds), the same group who may benefit from the option of either self-collected or a non-speculum clinician-collected sample in those who prefer it.⁴ Disparities in cervical screening participation occur by remoteness and socioeconomic status, with rates as low as 40% in some regions.³ Strategies such as mailing out self-sampling kits, as tested in a previous randomised controlled trial (RCT) by the same authors, hold the potential to overcome limitations in access to GPs, particularly in rural areas where difficulties in accessing care have the greatest impact on under-screened groups.