The 'DIY smear test' – everything you need to know but didn't want to ask
Smear tests are an unpleasant, but necessary, fact of life for women. Although cervical screening is estimated to save 5,000 lives a year in the UK, many women continue to put it off for any number of reasons - from having had a previously uncomfortable or painful experience, to embarrassment or cultural stigmas.
But a new scheme is looking to change that. This week, it was revealed that more than 31,000 women in London are being offered “do-it-at-home” smear tests to check for early warnings of cervical cancer, as part of a pilot run by NHS England, Public Health England and King’s College London. Experts believe these swabs could be a “gamechanger” in encouraging more women to get screened.
For many charities, it has been a long time coming. Denmark and Australia already offer DIY tests, and the UK is lagging behind. According to the charity Jo’s Cervical Cancer Trust, there is a backlog of 1.5 million smear tests that are missed by women annually. The latest NHS figures show uptake is at a record low among women over 50, with 73.6 per cent taking up invitations, while just 70 per cent of younger women are coming forward.
The pandemic has also had an impact: around 600,000 tests would have been carried out in the UK in April and May last year had screening services been operating normally, according to Jo's Trust - it's not known exactly how many have fallen through the cracks in the last year. Routine cervical screenings are now operating normally, but many women are still worried about attending.
So could a DIY test be the answer? Here is everything you need to know...
What is a DIY Smear Test?
During a cervical smear, your GP inserts a speculum into the vagina and the brush is used to collect cells from the surface of the cervix. Although it is called a ‘smear’ test, the DIY test is actually undertaken with a swab, rather than a brush.
Kate Sanger, of Jo’s Trust, says that this means the DIY tests are less invasive: you simply insert a swab into the vagina, and twist it around. The whole procedure takes a couple of minutes. Similar to an at-home Covid test (albeit in a different orifice), the swab is then placed in a prepaid envelope and sent off. If the results reveal a human papillomavirus infection (HPV), then their GP will invite you for a standard smear test to examine the cells in the cervix in more detail.
The DIY test is currently being trialled in London: women aged 25-64, overdue for a check and living in Barnet, Camden, Islington, Newham or Tower Hamlets will be offered a kit by their GP, or in the post.
How does it work?
Cervical screening tests check for human papilloma virus (HPV) infection. Sarah Graham, journalist and founder of women's health site Hysterical Women, says that regular cervical screenings now use a method known as "HPV primary", before they check for abnormal cells.
"When the sample is sent to the lab, the first thing that they check for is HPV, which is the virus that causes most cervical cancers. If the sample tests positive for HPV, then they will look to see if there are abnormal cells present,” explains Graham.
The DIY test is the same, only it checks for HPV cells, which live in the vagina, without the need to brush the cervix. HPV causes 99 per cent of cervical cancers, so if it is not present then your risk is minimal. According to Cancer Research, 99.8 per cent of cervical cancer cases in the UK are preventable. Experts hope that long-term, DIY tests will reduce the number of diagnoses by catching the disease early.
How does it feel?
Pain is one of the main factors that puts women off getting a smear test - something recognised by Sanger and her colleagues. While some women don't feel anything, others can find the experience distressing. This could be because they have a tilted cervix, have previously experienced sexual trauma or have a condition known as cervical ectropion - where glandular cells typically found on the inside of the cervix are found on the outside.
“For some people, it’s a really challenging test - so telling people to get on with it, and that it is quick and easy, can come across as shaming,” says Sanger. She hopes that people who feel pain during a smear may find the DIY test more comfortable.
The swab is similar to a “long cosmetic cotton bud”, explains Sanger, and doesn’t require a speculum - which some women find painful. “It’s a very simple test; it’s just a swab of the vagina and it doesn’t need to touch the cervix,” she adds.
Jess, 36, recently did a DIY smear test after finding the service was not currently available with her GP. Although she says she felt “sheepish” about the experience at first, and was concerned the swab wouldn’t hit the right place, she felt “more at ease” in the comfort of her own bathroom. “One leg on the bath and off you go. It didn’t hurt at all and you know, from that internal resistance, when you’ve found your cervix. In fact it was less uncomfortable than the cold, lubed-up clamp you’re normally subjected to,” she adds.
Sanger says she has heard people concerned that they won’t be able to do the test properly - but assures women they don’t need to worry. “The research and evidence is really positive and shows the majority of people can do the test perfectly themselves,” she says.
Will it be a gamechanger?
The short answer is yes, it could be. This is partly because it will hopefully encourage a higher number of women get tested. Attendance at cervical cancer screenings reached an all time low in 2018, and research shows that fewer women have been attending screenings during the pandemic. A survey undertaken by Jo's Trust of 851 women in the first week of June 2020 suggested that 25 per cent worry they will catch coronavirus, while 13 per cent thought it was best to put off going. This adds to the reservations many women already have about screenings: a third of respondents in a survey undertaken in 2018 said they were too embarrassed to go for a smear test.
As Sanger sees it, a test at home removes many of these anxieties.
“Hopefully, it should overcome a lot of the different challenges and barriers that are faced when attending screening. Long term, we hope this will bring the rates down, because people will be more willing to do it in their own homes,” she says.
The DIY tests are not intended to replace cervical screenings entirely, but they will help to screen people who would otherwise avoid attending an appointment. “These might be people with a past history of sexual assault, conditions such as vaginismus or trans men, and non binary people," says Graham. "There has also been a lot of regional variation over the pandemic: some people have been able to access services as normal, and others haven’t. Hopefully this will help to work through that backlog."
What are the symptoms of cervical cancer?
Graham stresses that it’s still important women are aware of the symptoms of cervical cancer, “because no screening process is perfect.”
According to Cancer Research UK, the most common symptoms are:
Unusual vaginal bleeding
Pain or discomfort during sex
Vaginal discharge
Pain in the area between the hip bones (pelvis)
She adds that cervical cancer screenings can also be a good time to have a general check in with your nurse, to chat about contraception, your cervix and your periods - so it is important to attend if you are over 25, and feel comfortable doing so.
