OnCo
ideasIdea

Post every woman an HPV self-test kit instead of asking her to book a smear

Many women never book a smear test. Sending a self-sampling kit by post, as the Netherlands and Australia do, reaches them and is just as accurate.

HPV self-sampling has equivalent sensitivity to clinician-collected samples for CIN2+ with PCR-based tests. Propose opt-out mailed kits as the default invitation for all eligible women, with clinician sampling as an alternative, and triage of positives by extended genotyping or methylation to avoid unnecessary colposcopy.

Hypothesis
Mailed default self-sampling raises screening coverage by at least 10 percentage points overall and 15 points in the most deprived quintile.
Rationale
Dutch, Australian and Swedish experience; removes clinic access barriers and embarrassment.
What would test it
Switch the national programme with a stepped-wedge evaluation.
Maturity
being tested at scale
Who has to act
policy
Cost to try
Medium ($1M to $50M)
Years to first evidence
3
Bottlenecks it attacks

Key papers

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meta analysisBMJ 2018changed practice
Self-collected HPV samples are as accurate as clinician samples and reach women who never attend screening

Women can collect their own screening sample at home with no loss of accuracy if the laboratory uses a PCR test. Sending kits directly is the most effective way to reach women who do not attend, which matters because most cervical cancers occur in under-screened women.

Connected

6top

Pages like this

not linked directly; found by shared links

cancers

1
Cervical cancer

fronts

2
Early Detection & ScreeningPrevention & Risk

technologies

1
DNA methylation profiling

bottlenecks

1
Prevention we already have is not deployed

key papers

1
Self-collected HPV samples are as accurate as clinician samples and reach women who never attend screening