Update: The launch date of the new HPV self-test has been delayed to 12 September. It will no longer be available on 26 July as previously announced.

For clinical reasons, some people will still be recommended to have a clinician-taken cervical sample, or you may still choose this option if you prefer it.

Cervical cancer is preventable through vaccination and screening – yet every year, 160 women develop it and 50 die from it in Aotearoa.

From July, people with a cervix will be offered a self-test for human papillomavirus (HPV) to screen for cervical cancer instead of doing the dreaded and uncomfortable smear test, which is a huge barrier for many.

So instead of getting your legs up in stirrups, having a speculum inserted, and someone scraping around - now it’ll just be like doing a Covid-19 test but down below. 

It’s the biggest change to cervical screening since it began in 1990 - what difference could it make?

Michaela Reid has had her fair share of smears over the years. 

“I find them uncomfortable and confronting. You just feel very vulnerable and just want them to be over,” the 30-year-old Aucklander says. 

One time Michaela woke up on the ground after getting a smear test as a student. 

“I woke up, and the nurse explained I had fainted and said I might have had what they call ‘cervical shock.’ 

“The nurse didn’t seem very phased or flustered about it. I had never heard about it before, but now I have heard of more people who have had similar experiences.” 

“The things we have to go through,” she laughs. 

The barriers of smear testing

For those that don’t know - a smear is where a clamp (called a speculum) is inserted into the vagina and spread open so that a health professional can take a swab of your cervix with a small brush. 

Because the procedure touches the cervix, it can trigger ‘vasovagal response’ - the stimulation of the vagus nerve which can make you lightheaded, sweaty, and dizzy. 

This can lower your blood pressure making you feel faint. 

Other side effects of smears are temporary bleeding (spotting) and cramping. 

New Zealand research has found the smear is a significant barrier to people getting screened for cervical cancer - especially for Māori, rural communities who have less access to care and people with low incomes.

Senior Māori health researcher and general practitioner Professor Sue Crengle says there are many barriers to smears.

“The fact that most have to pay for it is a major barrier, especially when you don’t have to pay for other cancer screening programmes like mammograms or bowel cancer screening,” Crengle says.

“For anyone who has had sexual trauma or negative experiences with health services in the past, that may mean that they're even less comfortable having a smear. 

“Also, most general practices are only open during normal office hours. But many people work normal office hours and can't get time off.”

Crengle says these barriers can disproportionately impact Māori - wāhine Māori die from cervical cancer at more than twice the rate of non-Māori.

However self-tests, which were trialled in Northland last year, have been described as “empowering” and “mana-enhancing” and are expected to increase participation.

Clinical modelling predicts the move to HPV screening will prevent about 400 additional cervical cancers over 17 years and save around 138 lives - a third of which would be wāhine Māori. 

So how does the self-test work?

A person will be handed a cotton swab and can go into a private space at a clinic to collect their sample. 

All you need to do is insert the swab a few centimetres into your vagina and rotate it for 20 to 30 seconds.

The swab will test for HPV, a sexually transmitted infection passed through skin-on-skin contact, which causes 99% of all cervical cancer. 

The results from self-tests are 99.8% accurate compared to the current accuracy rate of about 90%.

And HPV testing is more sensitive in detecting pre-cancer too, so tests will only be needed every five years instead of the current three.

Crengle says HPV screening combined with an uptake in young people getting the HPV vaccine “could not only eliminate almost all cervical cancers, but we'll also even be able to eliminate a whole lot of throat cancers, anal cancer, genital skin cancers too”.

She says it is important for young people to get the HPV vaccine before they are sexually active to give the body time to build immunity before contracting HPV. 

Because of the widespread prevalence of HPV, people can contract it “fairly quickly within a couple of years of being sexually active”, she says.

“It’s important that we frame this vaccine as an anti-cancer vaccine, because that’s exactly what it is.”

More work to be done

As someone who has had abnormal cells detected through cervical screening, Michaela says although she is a huge advocate for the screening process, she is relieved that she can now self-test. 

“I’m probably right at the top end of the spectrum of people who have a lot of trust in medical professionals and have a lot of access but even I dread smears,” she says.

“If in the future we could do this at home and there wouldn’t be this cost barrier, it would be life-changing for so many people.”

Crengle says the new programme is an important step but it only overcomes some barriers and doesn’t realise “the full potential” of HPV screening.

“Mail-out home tests would mean people wouldn’t have to get time off to see a doctor or have a conversation with a health professional beforehand if that is a barrier for them,” she says.

“[Te Whatu Ora - Health New Zealand] Waitematā have been doing trials of mail-out tests and have found it does increase uptake, especially among under-screened and never screened women.”

Another future option would be for people to be able to walk into a clinic, fill in a form and do the test for free without having to speak with a health practitioner.

Crengle says the programme being rolled out in July is not at that point yet. 

“That’s where we would like to be heading,” she says. 

“But for now, this is an important step in the right direction.”

You can find more information on the new HPV screening here.