Self-test for cervical cancer funded – Expert Reaction

A new test that gives women the option to self-screen for cervical cancer, and a more proactive breast screening system, will be funded in Budget 2021.

The changes aim to address long-standing inequities around cervical cancer and barriers to getting screened. The Government says only 61 per cent of eligible wāhine Māori are reached by the current cervical cancer screening programme.

The SMC asked experts to comment on the news. 

Michelle Wise
Mera Penehira
Bridget Robson
Nina Scott
Charlotte Paul
Beverley (Bev) Lawton
Kendall Stevenson

Dr Michelle Wise, Deputy Head of the Department of Obstetrics and Gynaecology, University of Auckland, and a Consultant Obstetrician and Gynaecologist at Auckland District Health Board, comments:

“I am grateful that the New Zealand government is finally rolling out a national cervical screening programme that it has been considering for years. A similar programme was implemented in Australia in 2017. But better late than never!

“The new approach of a primary HPV test every 5 years is based on science and follows the research evidence from around the world. The new programme has been shown to be more effective than 3-yearly smears, and just as safe. With these new screening guidelines we would expect fewer New Zealand women to be diagnosed with cervical cancer or die from this disease.

“Moreover, by enabling women the choice of a self-swab (rather than needing to have an in-person appointment with a doctor or nurse), the programme may reach women who would otherwise not have been screened, which hopefully will reduce inequities to cervical screening for vulnerable women.”

No conflict of interest declared.

Mera Penehira, Professor, School of Indigenous Graduate Studies, Te Whare Wānanga o Awanuiārangi, comments:

“The government’s announcement today on women’s health is monumental for whānau Māori and for Aotearoa/New Zealand. Why? Because there is a specific focus and ownership of the health inequities experienced by wāhine Māori in accessing preventative and treatment services for both cervical and breast cancer.

“Our survival rates are shocking when compared to non-Māori. As MP Kiritapu Allen recently advised, whilst non-Māori have a 40% chance of surviving the cervical cancer that she has recently been diagnosed with, as a wahine Māori, she has just a 13% chance of survival. This is absolutely unacceptable!

“Today’s announcement signals an investment in long-awaited change of these appalling health statistics. When we invest in wāhine Māori we invest in whakapapa Māori. When we invest in that, we invest in all who live in Aotearoa.”

No conflict of interest.

Bridget Robson, Associate Dean Māori and Director of Te Ropu Rangahau Hauora a Eru Pomare, University of Otago, comments:

“It is critical to improve access to breast screening for Māori women. Breast screening saves lives by detecting cancers early when they are less likely to have spread and are easier to treat. Māori women over 50 who are screened are more likely to have a cancer detected and must be prioritised. Māori women whose cancer is detected by the screening programme have a smoother more equitable path through diagnosis and treatment.  A lower proportion of Māori women are being screened regularly for breast cancer.

“An opt-off register that actively invites women to enrol in breast screening is one step to increase Māori access alongside other equity strategies. Women who opt off should have the opportunity to enrol at a future date and self-enrolment in breast screening must remain an option, especially for women who are not enrolled with primary care.”

No conflict of interest.

Nina Scott, indigenous public health physician and Chair, Hei Ahuru Mowai, National Maori Cancer Leadership Group, comments:

“The HPV self-test – with Māori governance – will save lives. Hei Āhuru Mōwai, in their position statement, called for the urgent implementation of a national HPV self-testing program alongside Māori governance over the National Screening Programme. Māori governance will ensure that the National Cervical Screening Programme and the Breast Screening Programme delivers on equity for Māori, because so far it hasn’t.”

Charlotte Paul, Emeritus Professor, Department of Preventive and Social Medicine, University of Otago, comments:

“I welcome the plan to improve cervical screening by introducing HPV testing, and especially improvements in the functions of the Register.

“It will be vital to ensure that monitoring of the new programme is established as a priority. The current website information on the National Cervical Screening Programme shows there has been no monitoring report since June 2018.”

Conflict of interest statement: “I have been a former teacher and mentor of Hon Dr Ayesha Verrall”.

Beverley (Bev) Lawton, Associate Professor and director of Te Tātai Hauora O Hine (Women’s Health Research Centre), Victoria University of Wellington, comments:

“The government has announced a $53 million investment to update the cervical screening programme in Aotearoa /New Zealand. We are delighted. This is very good news for the women of New Zealand.

“This new screen, HPV testing, is a better test and will save lives. Its simple, women can do it themselves or their doctor or nurse can do it.  Not only is this a better test it gives a woman the autonomy and control she needs.

“This change was proposed in 2017 and its a big thanks to the many organisations and the many individuals who have lobbied and petitioned for this better programme. On behalf of Te Tātai Hauora O Hine, our thanks to Minister Allan and her bravery for highlighting the need for women to screen.

“While this is good news, there are still outstanding issues as we move towards this high-quality programme. First, there is an urgent need for an interim solution for those women under screened or never screened – this cannot wait two years. Second, we need an efficient evidence-based pathway to treatment so women are not left in an unsafe holding pattern while awaiting much-needed treatment. It’s important women keep screening with smears while the new programme is being implemented.”

Conflict of interest statement: “I receive Health Research Council funding to study HPV self-testing. I have also previously been an advisor to vaccine companies, and have received travel and research grants from Seqirus, the company that supplies the Gardasil vaccine”.

Dr Kendall Stevenson, Research Fellow, Te Tātai Hauora O Hine (Women’s Health Research Centre), Victoria University of Wellington, comments:

“Finally, women have the opportunity to have a HPV self-test where they can retain their mana and rangatiratanga of their hauora. A great day, hari rangi māmā hoki.”

No conflict of interest declared.