You can help increase participation in cervical screening.
Talk to your patients about self-collection.
From 1 July 2022, the National Cervical Screening Program (NCSP) has expanded screening test options, offering self-collection as a choice to all people participating in cervical screening. Self-collection allows screening participants to have the ability to take their own vaginal sample for HPV testing; for many people removing a significant barrier to participation in screening. This means that all NCSP participants aged 25-74 years will have the choice to screen either by a self-collected vaginal sample or a clinician collected sample from the cervix (accessed through a healthcare provider in both cases). Healthcare providers are well placed to talk with patients about their cervical screening options to help them make an informed choice.
Importance of self-collection as an option for participants
Self-collection provides a level of control and choice for patients, removing a significant barrier to participation in screening.
There are some groups that are less likely to screen, including:
- Aboriginal and/or Torres Strait Islander women;
- culturally and linguistically diverse communities;
- people who identify as LGBTIQ+;
- people with disabilities;
- people who have experienced sexual violence;
- post-menopausal women;
- and people who have had previous negative cervical screening experiences.
Self-collection may be more acceptable to these groups.
Accuracy of a self-collected sample for the detection of HPV
Recent evidence has shown that the sensitivity and specificity of HPV testing to detect CIN2+ in self-collected samples were similar to those for clinician-collected samples when using validated PCR-based HPV assays.
A self-collected sample is taken from the vagina (not the cervix). It can be tested for the presence of the human papillomavirus (HPV) but not cytology (cervical cell abnormalities). If HPV is detected on a self-collected sample, depending on the type of HPV, it is recommended a patient should have a speculum examination with a cervical sample collected for liquid-based cytology (LBC), or be referred directly for colposcopy. A summary of the evidence of self-collection sensitivity can be found in the National Cervical Screening Program Clinical Guidelines.
Role of healthcare providers in self-collection
Healthcare providers continue to play a central and critical role in the NCSP, in assessing patient risk and using clinical judgement to recommend testing and follow-up.
Healthcare providers will still need to offer a consultation for cervical screening whether it be a self-collected vaginal sample or clinician-collected cervical sample.
During the consultation, healthcare providers will need to explain how to collect a self-collected sample, provide the swabs and offer information around test results and appropriate follow-up.
Where self-collection is chosen, patients should be provided with a private place within the clinic to collect their sample.
NCSP Clinical Guidelines
Self-collection of Cervical Screening Tests will be available for everyone who is eligible for the National Cervical Screening Program (NCSP), making it easier to participate, especially for people who have never screened or do not screen regularly. Updated NCSP clinical guidelines now provide the latest advice on the expanded eligibility to screen via self-collection, preparing health professionals for upcoming changes to the NCSP. The updated guidelines come into effect on 1 July 2022. You can download a PDF version of them now on the NCSP Clinical Guidelines website.
Professional development
Frequently asked questions about cervical self-collection
Unlike a clinician-collected sample, a self-collected sample is taken from the vagina (not the cervix). It can be tested for the presence of the human papillomavirus (HPV) but not cytology (cervical cell abnormalities). If HPV is detected on a self-collected sample, depending on the type of HPV, it is recommended the patient should have a speculum examination with a cervical sample collected for liquid-based cytology (LBC), or be referred directly for colposcopy.
From 1 July 2022 all NCSP participants aged 25-74 years will have the choice to screen either by a self-collected vaginal sample or a clinician-collected sample from the cervix, accessed through a healthcare provider in both cases.
Prior to 1 July, access to self-collection is only available for those over 30 years or older whom are more than two years overdue for screening or have never screened.
Self-collection is not suitable if the participant requires a co-test because they:
- have been exposed to diethyl-stilbestrol (DES) in utero
- are symptomatic e.g. experiencing unusual vaginal bleeding, pain or discharge
- have had a total hysterectomy with past history of high-grade squamous intraepithelial lesion (HSIL)
- are undergoing test of cure surveillance.
The requirements for requesting and processing self-collected tests differ across laboratories. If you have any questions regarding this process, contact your local pathology laboratory directly.
In Australia, the processing of self-collected vaginal samples for HPV testing under the NCSP is currently supported through three accredited pathology laboratories. These are:
VCS Pathology
Douglass Hanly Moir (DHM) Pathology
Sullivan Nicolaides Pathology
No. Recent evidence demonstrates a Cervical Screening Test using a self-collected vaginal sample is as accurate as a clinician-collected sample taken from the cervix during a speculum examination.
A self-collected sample is taken from the vagina (not the cervix) and is tested for the presence of HPV. For asymptomatic participants there is strong evidence that HPV tests on self-collected vaginal samples and clinician-collected cervical samples have equivalent sensitivity when using a Polymerase Chain Reaction (PCR)-based HPV test1 – the test used by the National Cervical Screening Program.
- A summary of the evidence of self-collection sensitivity can be found in the National Cervical Screening Program Clinical Guidelines.
- According to data from the National Cancer Screening Register, the current rate of unsatisfactory HPV samples (from self-collected samples) is under 2.6%2. This is well within the acceptable range.
- Self-collection is not recommended for patients that are symptomatic.
A self-collected Cervical Screening Test detects HPV DNA at levels associated with the presence of CIN2+ shed from the cervix. Therefore, as long as the sample is collected from the vagina, it will be accurate.
Patients that have difficulty collecting a lower vaginal sample by themselves could be assisted to do so by a healthcare provider. Alternatively, the provider could collect the sample using a self-collection swab without using a speculum. A sample collected in this way is still classified as self-collection on the pathology request form.
Among those attending for routine screening, approximately 2% have HPV 16/18 detected and approximately 6% have HPV (not 16/18) detected, although the latter varies by age. Over 90% test negative and can safely return to screen in five years’ time.
When deciding whether to choose self-collection or clinician-collection, patients must be given clear information by their healthcare provider about the likelihood that HPV may be detected and, if so, what follow-up will be required.
The National Cancer Screening Register (NCSR) enables healthcare providers to access and submit cervical screening data electronically in a self-service fashion.
To access and submit cervical screening data, contact the NCSR on 1800 627 701 or visit the NCSR website.