"Ultimately, we want every person with a cervix to feel empowered and able to access this vital screening test in a way that is acceptable to them."
Dr Deb Cohen-Jones says that self-collection tests are a great option for some, but not everyone. Image: iStockSource:BodyAndSoul
This week, Dr Deb Cohen-Jones explains the dos and don'ts of self-collection HPV tests, and why they might not be the alternative-for-all we first thought...
Got a personal health problem that you're too embarrassed to ask your GP, face-to-face? We feel you. Dr Deb Cohen-Jones is a W.A-based general practitioner who is passionate about breaking down stigmas around female health topics and separating facts from internet fiction. Which is why she's penning our Ask a Female GP column. You can DM us your own question for her via our Instagram, or email us at feedback@bodyandsoul.com.au.
"When I was training as a junior doctor, using dummy vaginas, and playing with metal speculums, I would never have believed that just over 20 years later, this examination would become almost redundant.
But while the announcement of self-collection tests is a huge progression forward for making this test available to all women, it’s not quite as simple as it sounds.
Even prior to this announcement, the national cervical cancer screening program has changed significantly in the last five years and many women are still uncertain about what these changes mean and how testing is now different.
Traditional, testing with a PAP smear relied on looking at the cells collected by the swabs taken during the test to detect any pre-cancerous changes. With the introduction of the HPV vaccination, as part of the national immunisation program, testing changed in 2017 to the updated cervical cancer screening test (CST) which looks for evidence of HPV (human papilloma virus) infection primarily to govern future testing and risk.
This is because we know that HPV (particularly strains 16 and 18) is the cause of almost all cervical cancers.
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Most cases of HPV infection have cleared within two years but those which persist may cause cell changes which develop into cancer. Simply speaking, if you don't have HPV on your CST, you are unlikely to develop cervical cancer in the next five years.
As a result, the updated recommended screening regime was changed to reflect this with women only being required to commence screening at age 25 rather than the previous age 18. Testing is then recommended every five years instead of the previous two years, ceasing at age 74 - if the test is negative.
This is what cervical cells look like under the microscope. Image: iStockSource:BodyAndSoul
As of July 1st, 2022, women can choose to screen through self-collection after consulting with their health professional.
This is ideally done at the clinic in a private space (in the bathroom or behind a screen), using a swab which is inserted into the vagina, rotated for 20-30 seconds, and then returned to your health care provider who will send it to pathology to check for HPV.
Recent evidence shows it is just as accurate to use self-collected samples to detect HPV as it is using clinician collected tests.
The benefit of having your clinician take the test is that if HPV is found, the cells can then be rechecked for abnormal cell changes.
In a self-collected test, which returns a positive for HPV, you will need to return to your clinician or specialist for further tests.
Traditional pap smears can be invasive and uncomfortable. Image: iStockSource:BodyAndSoul
The goal of self-collection is to maximise the number of women screened, and give women more choice in how they are screened. The statistics In Australia show that most women diagnosed with cervical cancer have never been screened, or do not screen regularly. There are still 800 women diagnosed with cervical cancer each year and 80 per cent were not up to date with their tests.
Often these are women who find screening painful, have cultural differences which makes screening more difficult, or are women who have experienced sexual assault - to name just a few of the extenuating factors.
Ultimately, we want every person with a cervix to feel empowered and able to access this vital screening test in a way that is acceptable to them.
It is also important to note that clinicians and specialists still recommend the healthcare-collected sample, using a speculum, to facilitate collection of cells from the cervix itself - which can be both tested for HPV and examined for changes.
One of Perth’s most well-regarded gynaecologists, Dr Jade Acton, was most emphatic in our discussions around this new option in that it should be reserved for women who would otherwise not have the test. Self-collected HPV tests should not be the first line option for screening, as cancers or other pathologies are more likely to be missed. Self-collection is a “better than nothing” option rather than an alternative.
As for the “home collection” option, this is an absolute last resort for women who would not have any screening otherwise. It is seen as the least accurate option.
I am very much aware that for women today, all these changes and options might seem overwhelming and even add to their stress. My advice is to talk to your healthcare provider when your test is due and in most cases, a quick speculum examination and CST remains the quickest and most accurate option.
For those of you who are unsure or just freak out at the thought of the traditional method, then self-collection is the test for you - as this is absolutely better than nothing."
Dr Deb Cohen-Jones is a practising W.A-based GP, with a keen interest in female health. Image: SuppliedSource:BodyAndSoul
Dr Deb Cohen-Jones is a Perth-based general practitioner with a special interest in cosmetic medicine, mental health, women's health, and dermatology. Dr Cohen-Jones is also the co-founder of highly acclaimed The Secret Skincare and is passionate about providing the most up to date effective prescription skincare to achieve optimum at-home results. You can follow her on Instagram here.
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