Do the Swab
New Zealand is nine months into the roll-out of a new cervical screening programme which includes a self-swab as an initial step. Dr Pip Shirley explains how this simple test aims to reduce cervical cancer cases.
Together with other nations, we’re working towards an ambitious goal developed by the World Health Organization, the ‘90–70–90’ target, as we informally call it. It states that by 2030:
- 90% of girls should be fully vaccinated against HPV (Human papillomavirus) by age 15
- 70% of women should be screened using a high-performance test by age 35 and again by 45
- 90% of those identified with cervical disease should receive appropriate treatment
So how is New Zealand going?
Our national target is for 75% of young people to be fully vaccinated against HPV – ideally before their first sexual encounter. But, as of July 2023, only about 57% of 13–14-year-olds had
been vaccinated.
There is a strong link between HPV, which is incredibly common, and cervical cancer. That is why vaccination is such an essential preventative measure.
Cervical cancer starts in the cells lining the cervix. It is triggered by cell changes caused by infection with HPV, so the second line of defence after vaccination is screening for HPV. In the past, cervical screening has involved a speculum examination and a cervical smear.
The National Cervical Screening Programme now offers the option of a vaginal swab test first. This can be carried out by your GP or practice nurse, at a Māori, Pacific or women’s community health centre, at a Sexual Wellbeing (formerly Family Planning) clinic or at an outreach service, like marae and mobile units. Self-testing is an option, and some providers may offer a take-home test.
Most test results (about 90%) come back normal. If a result comes back abnormal, the traditional smear test will be taken, followed by a colposcopy if needed. A colposcopy is an examination where a speculum is placed into the vagina and then a microscope is used to magnify the cervix. Two solutions are applied to the surface of the cervix to help identify any abnormalities. These can then be diagnosed further by taking a biopsy. Timetoscreen.nz has excellent plain language information for further reading.
85% of New Zealand’s cervical cancer sufferers have either never been screened or not opted for regular screening. We must do better.
If a smear is required, it is important to know that your gynaecologist and colposcopist understand the discomfort. Examinations are performed with utmost respect and we try to ensure they are as tolerable as possible. If it helps you to feel better prepared, consider asking for an initial appointment to discuss the process first. You are also welcome to bring a support person.
Remember that the purpose of screening is to review people with no symptoms to identify those who need to be offered early intervention and reduce adverse outcomes. The more people who participate in cervical screening, the more quickly we can identify those at risk of cervical cancer.
