Toolkit for engaging Under-screened and Never-screened women in the National Cervical Screening Program

Section 2 - Self-collection

Page last updated: 24 October 2020 (this page is generated automatically and reflects updates to other content within the website)

Changes to the 2016 National Cervical Screening Program Clinical Guidelines - Screening in pregnancy

The recommendations for screening in pregnancy in Chapter 14 have been modified to reflect clinical expert advice on the risks and benefits of self-collection of specimens for HPV testing during pregnancy.

REC14.13 Self-collection in pregnancy: Self-collection for HPV testing may be considered during pregnancy in never-screened or under-screened women, following counselling by a health care professional regarding the risk of bleeding.

Aims of self-collection in Cervical Screening
Eligibility for self-collection
Managing self-collection results
Practice-level considerations
Points to note when discussing self-collection
Healthcare provider resources
Consumer resources

Aims of self-collection in Cervical Screening

The Self-Collection Policy of the National Cervical Screening Program aims to improve participation in screening by providing an alternative screening process for asymptomatic women who are under-screened or never-screened.

Patients with symptoms that suggest cervical cancer need diagnostic testing rather than screening. Diagnostic testing involves a co-test and a gynaecological assessment, and may require referral to a gynaecologist for specialist gynaecological assessment. Therefore self-collection is not appropriate.

Eligibility for self-collection

Self-collection HPV testing is now a cervical screening option for under-screened and never-screened women. It is only offered in a clinical setting to women who:
  • have never had a Cervical Screening Test and are aged 30 years or over
  • are under-screened - defined as overdue for cervical screening by two years or longer and are 30 years of age or over. During the early years of transition to the renewed NCSP, this will mean greater than four years since a woman’s last conventional Pap test or greater than seven years since her last Cervical Screening Test.
Self-collection may be considered during pregnancy in never-screened or under-screened women, following counselling by a healthcare professional regarding the risk of bleeding.

Additionally, women who have experienced Female Genital Mutilation (FGM) may physically be unable to have a speculum examination or a Cervical Screening Test taken by a practitioner. They are also eligible for self-collection.

Managing self-collection results

If the self-collected sample shows that high-risk HPV has been detected the woman will need to return to her healthcare provider for further testing and/or referral to a specialist and should be followed up in accordance with the NCSP: Guidelines for the management of screen-detected abnormalities, screening women in specific populations and investigation of women with abnormal vaginal bleeding (2016 Guidelines).

Women who have HPV detected (not 16/18) and decline a follow-up test with a speculum examination should be offered a second self-collection HPV test in 12 months. This could be considered part of the same screening event because the women have not receieved a definite result. As this approach may delay diagnosis of abnormailities in under-screened women, it should only be an option for women who would otherwise by unlikely to complete the screening pathway, and who accept that they will need further testing if the second self-collection HPV test also shows oncogenic HPV detected (any type).

Practice-level considerations

A whole-of-practice approach to Renewal is recommended, with all staff adequately trained on the changes to the National Cervical Screening Program and self-collection. Services will need to determine which of their practitioners will provide self-collection consultations – nurse cervical screening providers, GPs or both, remembering that under-screened women are most likely to engage if they know and trust their health practitioners.

All health services should maintain comprehensive data on their patients’ screening history. Identifying under-screened and never-screened women and flagging them through patient records will help staff to opportunistically offer cervical screening, and potentially, offer self-collection to eligible women if they decline a Cervical Screening Test taken by a practitioner.

Self-collection must be requested and facilitated by a healthcare providers who also offers routine cervical screening services.

Self-collection must be offered and used appropriately.

Points to note when discussing self-collection

  • Only offer self-collection to under-screened women aged 30 years or over who meet the eligibility criteria above and have declined a Cervical Screening Test taken by a practitioner. Screening that is not in-line with current recommendations will result in an out-of-pocket fee for patients.
  • Be mindful of the barriers many under-screened women face in relation to cervical screening (See 1 – Addressing barriers to screening).
  • As these women are under-screened or have never screened, you may need to allow a longer consultation time for questions and to address any concerns. Some women may need more time to consider the test and could be booked to return at a later date. These options need to be weighed up with the possibility of the woman not returning, or of her considering the cost of a longer appointment to be a barrier.
  • Explain
    • What is HPV?
    • The importance of regular screening.
    • What the self-collection Cervical Screening Test is, noting it is almost as accurate as a health practitioner administered Cervical Screening Test but a healthcare provider administered test is the preferred option.
    • What different results indicate – it is important to prepare women for different possible results and the associated follow-up tests.
  • Check that the woman understands how to complete the test. (There have been cases where women have agreed to self-collection, but not taken a sample.)
  • Women should collect their sample whilst at your health service, either in the bathroom or behind a screen in the consulting room, and return it to you.
  • Some women who are eligible for self-collection may not be confident to take a sample themselves. They may prefer for their healthcare provider to take the sample for them during the consultation. If the Cervical Screening Test is completed by the healthcare provider with a swab and no speculum is used, it would still classify as self-collection.
  • Discussing results requires sensitivity. Consider how you will provide women with their results. Given these are under-screened women who may be anxious about screening, some health services make appointments for all women to return to receive their self-collection results, regardless of the result.
  • All women who have HPV detected will require further testing. It is very important to tell your patients that if HPV is detected they will need to come back for a conventional Cervical Screening Test taken by a practitioner, or be referred for a colposcopy.
  • Reinforce the need for regular cervical screening.

Healthcare provider resources

Consumer resources