On September 12, the cervical cancer screening programme is set to change. Out will go the old pap smear test, to be replaced with a newer test that checks for the human papillomavirus (HPV), which causes almost all cervical cancers.
This change has been in the works for a while – in fact, it was intended to have happened by now – but the process has been complex and costly. The silver lining is that the wait has provided a chance to review the experience in other countries, such as the UK and Australia, and design a system to work best here.
“Our programme in New Zealand will be one of the first in the world to be predominantly a self-test,” says Dr Jane O’Hallahan, clinical director of the National Screening Unit. “It’s a simple swab that you put into the vagina; it doesn’t need to go as high as the cervix, and we’ve had very good research groups that have shown women are able and confident to do it themselves. It’s a very sensitive test. If there is the precursor for precancers, the swab will find it.”
At least for now, women will be doing this self-test at a clinic – a GP surgery, Māori or Pacific health service or Family Planning. They can ask for assistance from a doctor or nurse if required. And those who want to stick with the old pap smear will still have that option, although the difference is the sample will be tested first for HPV rather than precancerous cells.
Cervical cancer is one of the most preventable and, when treated early, curable forms of cancer but still about 160 women in New Zealand develop it each year and 50 die. Globally it is the fourth-most common cancer in women.
“We believe this test will be a game changer in the fight against cervical cancer,” says O’Hallahan. “For women who have been reluctant to have a smear test, we have removed two barriers.
“One is the embarrassment or whakamā of having a speculum test and the other is the financial barrier. We have made very good inroads into the financial barrier with the $7.3 million funding Te Whatu Ora has announced.”
A free HPV test will be available for any woman aged 30 or over who has never been screened or hasn’t had a test in the past five years, as well as higher-risk people, Community Services Card holders and all wāhine Māori and Pacific peoples. “Māori and Pacific [people] are a priority because they have a higher incidence and death rate from cervical cancer,” says O’Hallahan.
HPV is a very common virus, spread through intimate, skin-to-skin contact or sexual activity. Four out of five unvaccinated adults will have it at some point. Generally, the body’s immune system fights off the infection but in some cases it will persist and can cause cell changes that may eventually develop into an invasive cancer. “We know that 85% of cervical cancers are in women who have never been screened or are underscreened,” says O’Hallahan.
If the swab shows a woman is free of HPV, she won’t need to be retested for five years (three if immune-deficient). When HPV is found, further testing will check for cell changes. This will involve either a smear test or, for those with higher-risk strains of the virus, a colposcopy, which is when the cervix is examined microscopically and biopsies may be taken. These procedures will be free.
“We are expecting there to be more pressure on colposcopy clinics for a period of time, but they’re gearing up for that,” says O’Hallahan.
It is still important for young people to be immunised against HPV. In New Zealand vaccine Gardasil 9 is free for everyone aged 9 to 26. However, even women who have been immunised need to participate in the screening programme, since the vaccine protects against the nine most common types of HPV but doesn’t cover them all.
The World Health Organisation is pushing for elimination of cervical cancer and this is certainly the aim in New Zealand. Lifting our vaccination rates is a key part of the strategy.
“We’re also hoping to engage more with communities that tend to miss out on screening services, such as those with mental illness or disabilities, and make sure they are part of this programme,” says O’Hallahan.
