DIY HPV tests being introduced in New Zealand next month could help eliminate cervical cancer

Self-tests for cervical cancer will be available in Aotearoa later this month, in the hope that more cervixes under the microscope will mean reduced rates of the disease - and maybe even eliminating it for good. 

From July 26, the primary test for cervical screening (previously called a 'smear' test) will change to a human papillomavirus (HPV) test, with the option of self-testing.

The cervix is a small, tunnel-like organ that connects the uterus and vagina. It allows fluids to pass between the two and widens during childbirth.

The cervix is also a common site for cell changes that may indicate cancer. According to Cleveland Clinic, the cervix is particularly vulnerable to the human papillomavirus, also known as HPV. Human papillomaviruses are a group of common viruses spread through skin-to-skin contact. Some are sexually transmitted, and can cause a range of cancers, including cervical.

However, there are ways to protect yourself. Getting vaccinated for HPV and having regular smears can help prevent the disease. A method of cervical screening, pap smears are typically carried out by a healthcare provider, who inserts a speculum to collect a sample of cells from the cervix for testing.

The cells are then checked under a microscope for any abnormalities that are indicative of cervical cancer. The test can also detect cell changes or irregularities that are precancerous, meaning they may lead to cervical cancer. 

According to New Zealand's Immunisation Advisory Centre, without immunisation, around 80 percent of adults will have a HPV infection at some time in their life. While most infections resolve within two years, the infection can remain after five years in about two in 100 people. Persistent infection can cause abnormal changes to cells in the cervix, penis, genital, anal and throat tissues in people of any gender, which can lead to cancer if left untreated.

"Everyone will come in contact with this virus. It's just those people who screen are less likely to get cancer," Professor Bev Lawton told The Project on Thursday.

The founder and director of Te Tātai Hauora o Hine (the National Centre for Women's Health Research Aotearoa) at Victoria University, Professor Lawton has been a significant contributor to advancing Māori health in the field of cervical cancer prevention, and has been an advocate and researcher for HPV self-testing.

It's hoped the new HPV test - a simple swab with no need for a speculum, that can be performed from the comfort of your own home - will remove barriers between women and healthcare and make it easier than ever for all women, but particularly at-risk groups such as wāhine Māori, to keep on top of their cervical health.

For most people, a speculum exam, or smear, won't be needed for the new HPV test, but it will remain an option and may be recommended based on individual circumstances and screening histories.

Unlike traditional pap smears, the DIY test is required once every five years instead of every three. According to Time to Screen, this is because the HPV test is a better first screening test and is more sensitive.

conceptual abstract image of the female reproductive system. Female uterus with vagina and ovaries
From July 2023, the primary test for cervical screening (previously called a 'smear' test) will change to a human papillomavirus (HPV) test, with the option of self-testing. Photo credit: Getty Images

Self-screening could also be the key to making a major dent in Aotearoa's rates of cervical cancer, which are currently on the rise, according to Professor Lawton.

"There's very few cancers that you can find a stage before it becomes cancer and you can do something about it," Lawton said. 

"Cervical cancer affects women when they are very young, relatively - so it's a devastating disease to get. Cervical cancer rates in New Zealand are increasing as we speak: that means women will die, who don't need to die."

The Project asked several Kiwi women for their thoughts on self-testing: while one said she would prefer to have it performed by a doctor ("so I know it's getting done properly"), others were supportive of the soon-to-be-available method. 

"It's easier to do it myself than having to go [to the doctor]. Number one, finding time to go, but also having a random [person] do it," one said, with a second adding: "It'll be better for a lot of people who have a fear of going to the doctor."

While screening 80 percent of eligible women is the goal, this year only 67 percent have been swabbed. In some groups, the rate is even lower: only 60 percent of eligible Pasifika have been screened, followed by 59 percent of Asian women and 55 percent of Māori.

It's hoped the new-and-improved test will make cervical screening more accessible and appealing for hard-to-reach groups - such as the rural and reluctant. 

Cervical cancer survivor Nairana Ormsby-Kingi had "put off and put off" her pap smear "because of life" - but when she eventually did find time, CN3 precancerous cells were found on her cervix. 

"Rather than investigating right then and there, I shrugged it off, thinking it might be alright in six months - but it's not the case," she told The Project. 

In that time her pre-cancerous cells had developed into stage 2 cancer. She eventually underwent six to eight weeks of treatment, spanning chemotherapy, radiation therapy and brachytherapy. 

"We put our tamariki first, our whānau first and ourselves, we get around to it when we can."

Ormsby-Kingi is now in remission, but not everyone is so lucky. Of the roughly 180 New Zealanders diagnosed with cervical cancer each year, about 50 die. 

Gynaecologist holding vaginal speculum - stock photo
For most people a speculum exam (used for the test previously known as 'smear') won’t be needed for the new HPV test. Although this is still an option if you prefer, and may be recommended based on individual circumstances and screening histories. Photo credit: Getty Images

Unfortunately, cervical screening is the only national screening programme that isn't free, and self-testing is no different. It will cost anywhere from $40 to $100, depending on your GP. 

"This has lost us sleep, trying to get this funded," Lawton said. "Because of the fact it's not funded, women without access to this are [at risk] of getting cervical cancer - and dying - and they don't need to."

With the combination of the HPV vaccine - which was rolled out to New Zealand pre-teens in 2008 - widespread screening, and increased self-testing, experts say elimination of cervical cancer is possible, but everyone with a cervix needs to be getting it checked in order to do so. 

About the new test

  • For most people, HPV screening will replace the smear test.
  • This new screening can be done as a simple vaginal swab. You can choose to do this as a self-test in a private place in a health clinic (such as behind a curtain or in a bathroom), or you can have your doctor or nurse assist you.  
  • Most healthcare providers will have a private space in the clinic for you to do the test, but you can talk to your them about other options, such as testing at home.
  • You can choose to continue to have the smear test. 
  • For most people regular screening will now only be needed every five years (or every three years if you are immune deficient).  
  • To get the new test you can go to your usual screening provider, or you can choose another option (e.g., a hauora provider or Family Planning clinic).
  • There's usually a fee charged for screening. Some GP clinics, Māori and Pacific providers and community clinics offer a free or low-cost service. 
  • Cervical screening is available to wāhine/women and people with a cervix aged 25 to 69 who have engaged in any sexual activity, no matter their sexual orientation. 
  • Most people who are eligible for the National Cervical Screening Programme will be offered the new test as part of regular screening when it becomes available. You automatically become enrolled for cervical screening when you turn 25 and have your first cervical screening test. If you're not sure if you're on the National Screening Register, call 0800 729 729 and check.

Time to Screen

Watch the video above.