Māori women are more than twice as likely to develop cervical cancer than Pākehā and researchers say offering self-testing for the disease could close the gap.
Cervical cancer is diagnosed in about 160 New Zealand women each year, with most occurring in women who have either not received screening or had infrequent screening.
Māori women are less likely to attend regular screening than Pākehā women, 34 per cent compared with 21 per cent, and are twice as likely to be diagnosed with, and three times more likely to die from the disease.
Cervical cancer is the second leading cause of cancer death for Māori women aged 25–44.
A study, led by Victoria University of Wellington's Te Tātai Hauora o Hine Centre for Women's Health Research, surveyed 500 Māori women who had not been screened regularly, about whether they would want to do a new self-test looking for the cancer-causing human papilloma virus (HPV).
Research fellow Anna Adcock said HPV screening was more effective at preventing cervical cancer and its associated premature death than the current smear test, and the new technology enabled women to screen themselves.
The study found the most frequently-cited barrier to current screening for Māori women was whakamā—embarrassment, shyness, and/or reticence. A lack of time, cost, travel, and fear of discomfort or pain were also leading barriers.
"Less Māori women are being screened so more are developing cervical cancer, which is a very preventable disease," Adcock said.
"With whakamā sometimes participants felt health services were not always welcoming, or they had not been treated very well at a past screening, or had another sexual health check where they did not feel comfortable."
Three out of four study participants said they would be "likely" or "very likely" to do a self-test for HPV, with nine out of 10 reporting being "likely" or "very likely" to attend a follow-up if they tested positive.
"Our findings suggest that, implemented in a flexible and culturally sensitive way, HPV self-testing could be very acceptable for Māori women who find current screening unacceptable," Adcock said.
Rotorua woman Talei Morrison, who died in June last year from cervical cancer, started the Smear Your Mea ("smear your thing") campaign as when she was diagnosed she said there no resources that connected with her as a Māori woman.
She encouraged women to have their smear tests done before performing at regional kapa haka events, as she didn't want any other woman to be stripped of her right to perform kapa haka because of cancer.
While they only surveyed Māori women, Adcock said she imagined many women would prefer a test that was painless and less invasive.
In a randomised controlled trial in Northland 45 per cent of women who had either never been screened or underscreened took the HPV self-test over the smear test.
"This shows women like doing their own test," Adcock said.
The findings were informing the Ministry of Health's National Cervical Screening Programme, which was exploring self-testing as an option once HPV primary screening was introduced.
HPV screening was due to be introduced in New Zealand last year, but had been delayed to 2021.
Former Health Minister Jonathan Coleman announced the change to HPV screening in 2016, saying the change was expected to reduce cervical cancer deaths by 16 per cent in unvaccinated women.
Adcock said research showed evidence was "piling up" that HPV screening was more effective than the smear test used at present, and the self-test was just as good as a clinician taking the sample.
"Self-collected vaginal specimens can be used for HPV screening and recent evidence suggests they provide sensitivity and specificity equal to clinician-collected specimens for detecting high-risk HPV types.
"It is really exciting technology where women can be in control of themselves.
"We need to implement this new cancer prevention screen as soon as possible to save lives."
The study was conducted through face-to-face hui (meetings) and a survey with the participants, as well as healthcare providers such as smear/sample takers, general practitioners, nurses and clinic staff.