Using an HPV test for primary cervical screening from July 2023
By Dr John McMenamin, GP lead, National Screening Unit
27 September 2022
From July 2023, the primary test for cervical screening will be a test for human papillomavirus (HPV), which causes over 95 percent of cervical cancers.
Self-testing will be an option for everyone who needs to provide a vaginal swab sample. The cervix does not need to be reached with the sampling device, making it a simple test for participants. It can be done in the clinic, at home, or other community settings but clinical oversight is required in order to explain the test, manage results and arrange follow up.
Participants can choose how to have their screening test: either take it themselves or have a clinician take it for them. The clinician can take a vaginal swab sample which will be managed by the lab as a self-test; or the clinician can take a liquid-based cytology (LBC) using a speculum. For primary screening, a LBC sample will be tested for HPV initially and reflex tested for cytology if the HPV test result is positive.
The simplicity and privacy of self-testing means it will reduce barriers for all participants and will increase access to the clinical pathway for Māori and Pasifika.
Participants need to be reassured that a self-test is just as effective as a clinician-taken sample at detecting the presence of HPV.
Clinical oversight for self-testing means that for every self-test sample, there is a health professional who signs the laboratory request form and who is responsible for:
- providing advice and obtaining informed consent
- providing the test kit to the participant/coordinating getting it back (tests won’t be sent out centrally)
- ensuring the correct lab request information is provided on the request form and that the request form is signed by them
- ensuring the participant is told of the test result and the result is followed up and the next steps/referrals are completed as needed.
Protocols to manage results will be formalised before the programme starts, based on this guidance:
- HPV not detected -> five-year screening interval.
- HPV 16/18 detected -> option of returning to primary care for a cytology sample or direct referral to colposcopy, where cytology will be taken.
- HPV other (non 16/18) detected -> Cytology sample required:
- Normal / Low-grade cytology -> repeat HPV Test in 12 months
- High-grade cytology – referral to colposcopy.
The National Cervical Screening Programme (NCSP) register will be population-based, sourced from NHI data and include both those already enrolled in the NCSP and those who are unenrolled (with an opt-off option). The register will provide direct look-up access for primary healthcare and provide centralised notification to let participants know it is time to get screened. This notification is not an invitation, which will still come from primary care.
Clinicians will continue to provide communication with patients about screening, take responsibility for test delivery and results, and ensure appropriate clinical follow up of abnormal results.