Self-collection of cervical samples may increase HPV screening rates

An Australian program that offered self-collected cervical samples to all eligible women raised uptake of HPV screening, especially in underserved groups, and found similar detection of high-grade lesions and cancer compared with clinician-collected samples.

Australia expanded an organized cervical screening program to offer self-collected cervical samples to all women aged 25–74 in July 2022. The program is part of ongoing monitoring by the national cancer screening registry and is the first national program to offer self-collection alongside clinician-collected sampling in primary care. Investigators analyzed registry data from December 2017 to December 2023 for test uptake and compared diagnostic findings among women referred for colposcopy from July 2022 to June 2023. The study and a linked commentary examined participation, test positivity, follow-up, and implications for equity and program implementation. Key findings: - Uptake of self-collected samples rose from 1.2% in Q2 2022 to 26.9% in Q4 2023 after eligibility expanded to all women aged 25–74. - Participation was highest among women more than 10 years overdue for screening (51.9%), those in very remote areas (53.9%), those in disadvantaged areas (29.1% or higher), and people aged 70–74 (33.5%). - From Dec 2017 to June 2023, 4.9 million women were tested with 9.8% test positivity; from July 2022 to June 2023, 421,511 women were tested with 15.1% positivity. HPV positivity was higher in self-collected samples than clinician-collected samples (16.4% vs 14.8%), with baseline differences between groups. - Loss to colposcopy follow-up was greater for women who self-collected when referral relied on cytology before colposcopy, although most serious abnormalities among those with high-grade lesions detected on self-collected samples were identified at colposcopy before cytology results were available. - Among women referred for colposcopy, adjusted analyses showed similar identification of high-grade lesions and similar histological detection of cancer between self- and clinician-collected samples (reported adjusted odds ratios around 0.87–1.20 for the comparisons reported). Summary: The expanded offer of self-collection was associated with substantially higher uptake, particularly among historically underscreened groups, while detection of high-grade lesions and cancer in women referred to colposcopy was similar between self- and clinician-collected samples after adjustment. The authors and commentators noted implications for equity, program reach, and potential resource effects, and they reported that timely follow-up and clinician support were important to maximize benefits. Undetermined at this time.