The NHS has begun sending at-home HPV self-testing kits to four million women in England who missed their booked cervical screening appointment, in a drive to raise uptake and prevent more cases of cervical cancer.
From today, eligible women who did not attend an in-person smear test will receive an invitation through the NHS App, by text message, email or letter. They can then order a free self-sampling kit through the app or their NHS online account.
Women aged 25 to 64 are normally invited for cervical screening at their GP surgery every five years, unless they are considered high risk. The standard test involves a nurse inserting a speculum into the vagina to view the cervix, the opening to the uterus, and take a sample of cells that is checked for human papillomavirus, or HPV, the virus responsible for 99 per cent of cervical cancers.
Eve Simmons, a health editor who trialled the new approach, was one of 27,000 British women who took part in an earlier pilot of the self-sampling kits. She completed her test in around two minutes in an office toilet during a coffee break, and described the traditional smear as vaguely uncomfortable but not a problem, though friends of hers had found it painful.
How the DIY kit works
The self-testing kit contains a swab, similar to a long cotton bud, used to collect a sample from the vagina. No speculum is needed. The swab is inserted about as far as a tampon, twisted for 20 seconds, then placed in a small tube and posted back to the NHS free of charge for analysis.
Simmons said there was no pain, only a slight scratchiness similar to removing a tampon. Studies show fewer than one per cent of women fail to complete the test correctly.
If a sample comes back positive for high-risk HPV, the type that can develop into cancer, the woman will be invited to a follow-up cervical screening appointment at her GP surgery or a sexual health clinic, where a nurse or doctor will take a sample directly from the cervix to check for cell changes.
Why screening uptake has fallen
Only around 60 per cent of eligible women currently attend their scheduled cervical screening. Research by cervical cancer charities has found embarrassment is a significant factor, particularly for women from certain cultural backgrounds, while for roughly half of no-shows the barrier is difficulty getting time off work or finding a convenient appointment.
The self-testing trial Simmons joined was run by scientists at King's College London in partnership with NHS England, and was among the first to test appetite for the technology. She recalled being taught the so-called mirror test at school, where girls are told to examine their own anatomy with a mirror, an exercise she said she had never done.
The shift to HPV testing
Dr Anita Lim, lead researcher on the King's College London study, said traditional smear tests involve taking cells specifically from the cervix, and that the person carrying out the test needs a speculum to move other tissue aside to find it.
Since 2019, doctors have moved towards testing for HPV first. The virus is transmitted during sexual activity and is effectively endemic, with up to eight in ten people thought to be carrying it at any given time. It is usually harmless, but a handful of its roughly 150 strains can, in some cases, cause cells in the genital tract to mutate and become cancerous. Because the virus can be found throughout the vaginal canal, a sample is straightforward to collect.
Around the same time the London trial launched in 2021, results from Scottish trials showed self-sampling was as accurate as the in-clinic test.
Expert reaction
Dr Adeola Olaitan, a consultant gynaecologist at University College London Hospitals NHS Foundation Trust, said campaigners had for years been asking why women could not simply swab themselves, noting the practice was already established in countries such as Denmark and Australia. "Covid sort of revved everything up a gear," she said.
"This is the future of women's healthcare, more choice, more freedom," said Dr Lim. "It removes the invasiveness and embarrassment and, instead, empowers women to protect their own health. There's plenty of robust evidence to show this works, so it was only a matter of time before it became available to NHS patients."
Women using the DIY kit will miss out on the visual examination carried out at a GP surgery, which can spot other abnormalities such as infections or non-cancerous growths called polyps. However, studies suggest such incidental findings occur in only seven per cent of appointments.
A positive HPV result does not mean a person has, or will get, cancer. "HPV is very common in women under 25, and it's extremely rare for it to develop into cervical cancer," said Dr Jo Waller, an expert in cervical cancer prevention at King's College London. "In young women, HPV usually goes away on its own and causes no problems. Some people liken it to a cold for the genitals. More often than not, the immune system clears it up and you'd never know you'd had it."
Roughly 20 in every 100 women have a tilted uterus, where it hinges backwards rather than forwards at the cervix, a condition that can make speculum exams painful. Dr Olaitan said such patients would also benefit from the DIY test. "The beauty of this test is it doesn't force women into an uncomfortable position," she said. "You don't have to see the cervix to get the sample. And there's no lying down on a bed, you can do it in whichever position is easiest. Basically, anyone who can insert a tampon can take their own swab."
Dr Sue Mann, national clinical director for women's health at NHS England, said offering millions of women an alternative test they could do from home would be a gamechanger, making it easier than ever to get tested for HPV. "If you're invited to take part, please order a test, it's a simple swab you can do at home in minutes," she said.
Experts stress cervical screening appointments with a clinician remain the best way to help prevent cervical cancer, with HPV self-testing offered as an additional choice.
A few days after her self-test, Simmons's result came back negative, a result she had largely expected after a normal smear test two weeks earlier.
