By Sinéad Woods, Senior Public Health Officer, National Screening Service
We’ve recently completed research to better understand the potential role of HPV self-sampling for cervical screening in Ireland. It’s part of our work to increase uptake in cervical screening and make it more equitable. It’s also on our roadmap to Cervical Cancer Elimination.
Why we did the research
We wanted to understand more about women’s attitudes and preferences to HPV self-sampling and whether they would be interested in using this method of screening through the CervicalCheck programme.
How we did the research
The research was survey-based and was overseen by a research advisory group with ethical approval granted by the Royal College of Physicians Ireland ethics committee. 2,024 surveys were completed - 1,437 online and 587 face-to-face.
We used a technique called ‘quota sampling’ so that we could represent the views of a diverse group of women of different ages, backgrounds and from different places. We also wanted to capture the views of women who had different experiences of cervical screening as follows:
- Regular attenders (attended within 6 months of being invited)
- Under-screened (attended after 6 months of being invited)
- Never screened (never attended for cervical screening)
- Pre-eligible (those aged 20-24 years who have not yet become eligible for cervical screening)
The survey asked women their intended preferences for self-sampling or for screening as normal with a GP or practice nurse, before and after being shown additional information on how to take a self-collected sample. This enabled us to capture women’s initial thoughts and then a more informed preferred choice.
What we found
We found little difference between the preferences of survey participants before and after being shown the additional information. There was a small increase of women who would choose a self-sampling option (from 51% to 54%). The percentage of those who would continue to attend screening as normal remained unchanged at 42%.
The additional information did help some of those who were undecided to choose an option. 6% were undecided before being shown the additional information, which reduced to 4% after viewing the information. 1% of women said they would not attend for screening when they are next invited. This remained unchanged before and after being shown the additional information.
Results by screening experience show that 65% of those who were never screened and 62% of those who were under-screened would choose self-sampling. 41% of those who have attended cervical screening regularly would choose self-sampling.
What this tells us
These preliminary results are the first indication that the introduction of HPV self-sampling has the potential to increase the number of women who participate in cervical screening in Ireland. If self-sampling was offered through the CervicalCheck programme, a substantial number of regular attenders would continue to choose going to their GP or practice nurse for cervical screening. Women who were never screened or were under-screened would choose the self-sampling option.
Commenting on the research findings, our Director of Public Health, Dr Caroline Mason Mohan said: “This research has come at a good time in Ireland as we announce the date we expect to reach elimination of cervical cancer in Ireland. This research highlights that a self-sampling option would appeal to our never and under-screened populations and our priority remains ensuring that everyone who is eligible for screening has the opportunity to attend. We will continue to be guided and informed by international evidence on HPV self-sampling while also now adding Ireland’s voice to the evidence base and conversation”.
What’s next for HPV self-sampling in Ireland
We’re considering the survey findings alongside the results of our survey on the attitudes of sampletakers towards self-sampling. We’re also considering additional research that would further inform how self-sampling could be introduced in Ireland. The CervicalCheck programme is considering options for implementing a self-sampling option, including careful consideration of what areas of the screening pathway would be affected.
We will continue to look to our international colleagues and countries where self-sampling is being offered in cervical screening programmes to learn from their experiences, research and recommendations.
- All research results are preliminary. Finalised results will be published at a later date.
- The research was carried out between May and August 2023 by Behaviour & Attitudes, on behalf of the National Screening Service. Thank you to all the women who completed the survey.
- Changes to population screening programmes in Ireland, including CervicalCheck, must first be evaluated by the National Screening Advisory Committee. This independent committee makes recommendations to the Minister for Health and the Department of Health. When recommendations are accepted, they are then communicated to the HSE and the National Screening Service begins the planning phase of implementation.
- Learn more about the background to this research.