By Dr Laura Heavey, Consultant in Public Health Medicine, National Screening Service
We are designing a feasibility study of HPV self-sampling in cervical screening. Our study will help us understand more about the changes we would need to make to our CervicalCheck programme to be in a position to offer self-sampling to women who will most benefit from it, if it is recommended by the National Screening Advisory Committee. This independent committee makes recommendations to the Department of Health about changes to population screening programmes and is reviewing self-sampling. The results of the feasibility study will be shared with the committee to support its review.
About the feasibility study
We need to carefully assess how self-sampling fits into our CervicalCheck programme, and to determine its value and effectiveness for women in Ireland.
The study will:
- evaluate the resources needed to deliver self-sampling
- collect feedback from women who take the self-samples, as well as their doctor or nurse
- identify potential challenges.
What we would need to consider
Screening is more than a test. It’s a full pathway of care from the invitation to take part right through to the treatment of any disease that’s identified. We always need to consider the full pathway when making any changes to our CervicalCheck programme.
- Women who test positive for HPV on a self-sample will need to go to their GP, practice nurse or clinic to give another sample so that cells from the cervix can be sent to the laboratory for cytology testing to check for abnormal cells.
- When abnormal cells are found, women are referred to colposcopy. When abnormal cells are not found but HPV is present, women are asked to come back for another cervical screening test in one year. We need to consider if this repeat test could be a self-test or if it needs to be a sample taken by a clinician.
- Self-sampling would affect the way samples are processed in the laboratory. We need to make sure that self-sampling kits work well with our HPV analysers – the machines that test our samples.
- Self-sampling would affect how we record test results on the cervical screening register.
- We would need to develop a suite of new, accessible information materials for women about self-sampling and how to take a self-sample correctly.
- We want HPV self-sampling to increase participation in cervical screening, protecting more women from cervical cancer and bringing us even closer to cervical cancer elimination. While some countries including the UK and the Netherlands are seeing a decline in participation, we have high participation rates in Ireland (78%) - well above the OECD average of 55%.
What the evidence is telling us
We know from research that the delivery of HPV self-sampling must be adapted to the local context – it’s not a one-size-fits-all approach.
- HPV self-sampling will appeal to some women who don’t come for screening, not all of them.
- HPV self-sampling will not remove all the barriers to screening participation and it won’t solve all inequities.
- The evidence is suggesting that it’s better for women who already go to their GP or practice nurse for cervical screening to continue to do this rather than switching to self-sampling.
- Our survey of over 2,000 women living in Ireland has shown that the introduction of self-sampling could increase the numbers of women taking part in cervical screening, and help to improve equity in screening.
- Another study of 200 sample takers in Ireland shows that the majority of GPs and practice nurses are supportive of the introduction of HPV self-sampling in cervical screening.
- In June 2025, the UK National Screening Committee recommended that a self-sampling test option should be offered to women who never or rarely attend their routine cervical screening appointments. The committee is only recommending the offer of a self-sampling option to under-screened women. It agreed that this option is better than no test at all for those who do not access screening. It has asked for further studies to find out whether self-sampling could be offered and used effectively across the whole population. The committee said: “There is still uncertainty as to whether self-sampling is as good as clinician testing for women who already attend screening regularly”.
Improving equity in screening
Community engagement is playing an important role in improving equity and supporting women to come for screening. We know from our community champions work that many women who have not engaged with cervical screening before need more than an offer of self-sampling to support them to take part. We will keep working with under-screened groups, including migrant women, people with intellectual disabilities, women in socially deprived areas and LGBT+ individuals, to address the specific barriers that can prevent them from taking part and support more women to choose screening.