Self-collection increases access to cervical screening

Despite cervical cancer being recognised as a preventable disease, rates among Indigenous women remain incredibly high — 3.9 times that of other groups. But a new screening method is breaking down cultural barriers to improve disease prevention.

Australia has been leading the charge against cervical cancer for many years now. Thanks to developments including Gardasil and an improved national screening program, we’re well on our way to eliminate cervical cancer by 2100.

However, many Australian women remain at a high risk of cervical cancer, in particular, among Indigenous, culturally and linguistically diverse and rural and remote women.

Data has demonstrated that at least 80% of women who develop cervical cancer in Australia are not up to date with their screening or have never been screened. Meaning the best way to improve health outcomes for these women is to improve access to culturally appropriate screening methods.

There are many reasons women may not feel comfortable with a traditional cervical screen collected by a doctor or nurse. Self-collection was developed to break down some of these barriers and improve screening rates, ultimately saving women’s lives.

Self-collection allows women to take their own vaginal sample for HPV testing and is available to women at least 30 years of age who haven’t had a Pap smear for four or more years or who have never been screened and who decline a traditional screening test.

Australia was the first country to endorse self-collection in its national screening guidelines, which became available from January 2018.

VCS Foundation was the first laboratory to be accredited to support testing of self-collected samples and has been supporting health professionals to access the test from anywhere in Australia. Additionally, we provide training to health staff on the method and improving safe practice and a culturally appropriate approach to consultations.

To ensure more high-risk women have access to this lifesaving test, we recently completed a series of self-collection education programs for healthcare workers in rural South Australia including the communities of Mount Gambier, Port Augusta and Port Lincoln. The initiative was jointly funded by SA Health and the Australian Government Department of Health.

Self-collection training participant and rural generalist Dr Bas Kirmani, of the Royal Flying Doctor Service, South Australia, said GPs, nurses and Aboriginal workers each played important roles in promoting and undertaking screening pathways.

“It’s fundamental to good health care to prevent diseases like cancer before they become life-threatening,” he said.

“That’s just common sense: you can spend your energy treating cancer once it has happened or you can put your energy into ensuring it doesn’t emerge in the first place. This program does that, for a particularly vulnerable population.

“Cancer is the second most common cause of death among Aboriginal and Torres Strait Islander people and is anticipated to become the primary cause of death in the next 10 years.

“Aboriginal [people] and Torres Strait Islanders diagnosed with cancer are usually younger, have more advanced and more lethal types of cancers than other Australians and are significantly less likely to survive five years after their initial cancer diagnosis.

“It’s true that self-collection is not a one-size-fits-all solution, but this method will allow more women to feel comfortable and safe during screening, greatly increasing the chances of uptake and therefore early detection and treatment.

“In our own experience, women are really comfortable with the design and intent behind the program, and the fact that screening frequency has dropped from every two years to five-yearly more or less sold itself — people are really happy with that.

“With the extra benefits of the self-collection program for those women who have fallen behind or out of the screening program, this is a way of conveniently helping an enormous number of women.

“Our patients understand that, and are willingly on board.”

*Dr Lara Roeske is VCS Foundation’s Director of Medical Education.

Top image: A training session in Port Lincoln. Pictured, from left to right, are: Jessica Collins; Dr Lara Roeske, VCS Foundation; Dr Sam Olaiya, GP, Port Lincoln; and Vicky Fisher.