For more than 30 years, Aotearoa has been offering smears to eligible people every three years, as a screening test to detect early changes on the cervix that may lead to cervical cancer.
Right now, this involves visiting your doctor and having a speculum inserted into the vagina, so the doctor can take a sample of cells from the cervix.
For some people, this is no bother and the smear itself causes little to no discomfort. But others may find it embarrassing or even painful — enough to be put off screening altogether, sometimes. There are also equity barriers to screening, including cost, transport, time, and access to appropriate and culturally safe services.
New Zealand also has big inequities in cervical cancer rates: Māori and Pacific peoples have lower rates of cervical screening, higher rates of cervical cancer, and are also more likely to die from it.
So, from July next year, New Zealand is moving to a new better screening programme, testing for the human papillomavirus (HPV) every five years instead.
With the new test, that speculum is optional, and a swab is taken from the vagina, instead of cells from the cervix, to test for the HPV virus. You can even do it yourself.
But is it as accurate as the old way? And is it better to get a doctor or nurse to do the swab?
Experts agree that the HPV self-testing programme is more effective and accurate than the pap smear programme at preventing cervical cancer.
Cervical cancer comes from a persistent viral infection of HPV. HPV is common and normally resolves itself within two years, but is a problem if it persists.
The old smear screening test looks for threatening cell changes in the cervix that warn of possible pre-cancer changes. The new screening test looks for the presence of HPV — the earliest warning sign — instead. It's expected to prevent 15% more cancers than the old smear programme.
It’s a PCR test — yep, the same technology we use to accurately test for Covid — and the results are black and white. Either HPV is there, or it isn’t.
If it’s not, the science shows that those people are unlikely to be at risk of cervical cancer for another five years, when their next screening is due.
If HPV is present, that means further testing. This can involve an exam using a speculum, or a colposcopy test, to check for cell changes or diagnose pre-cancer if it's present.
The other big change is that patients can perform the HPV test themselves if they want to. Research from a pilot study here in New Zealand found that people like the idea of this. It’s expected to increase the proportion of eligible people having a test.
Whether you do the test yourself or have a health worker do it for you, the accuracy will be the same. There is little risk of doing it wrong and getting an inaccurate result.
What about the longer time between screenings? Is that safe?