Petition Number: P-06-1397 Petition title: Introduce an at-home smear test option in Wales Text of petition: Cervical cancer is the most common type of cancer in women under the age of 35. According to Cancer Research UK, 99.8% of cases in the UK are preventable. Smear tests can save lives by detecting any pre-cancerous changes early when treatment is more effective. Currently there are barriers preventing women and those assigned female at birth from accessing this service. England have trialled at-home smear tests, and we believe the option in Wales can help break down these barriers and save lives. There are reasons why women don’t attend their cervical screening tests. Including but not limited to:- Embarrassment Lack of education Not identifying as a woman Low perceptions of risk Mistrust in health services Cultural barriers Concern over the procedure Body image issues Trauma - sexual assault, rape Inconvenient appointment times This was trialled in London in 2021. Dr Anita Lim, from King's College London, who lead the YouScreen trial, said: "It is crucial that we find ways like this to make screening easier and protect women from what is a largely preventable cancer. Self-sampling is a game-changer. This simple and convenient swab means it can be done in the privacy and comfort of your own home." Welsh women's rights Activist, Molly Fenton, says "Ideally we need a lot to change: better education, stigma breaking conversations and reassurance around the procedure, but in the short term this could save a lot of young lives. Especially 25 year olds taking that first test.”

 

1.        Background

Cervical Screening Wales is responsible for the NHS cervical screening programme in Wales. Cervical screening can prevent cervical cancer from developing, or pick it up at an early stage. The cervical screening (smear) test looks for high-risk types of Human Papillomavirus (HPV) that can cause cell changes on the cervix.

Self-sampling means people can take their own vaginal swab, which may be done at home or in a clinic. It is not routinely part of cervical screening  programmes in the UK.

This BBC article (August 2023) highlights campaigners’ calls for at-home smear tests in Wales.

Cancer Research UK says initial findings from research on self-sampling are positive, but more research is needed to better understand the feasibility of introducing self-sampling into cervical screening programmes, including clinical and cost effectiveness, as well as any impact on inequalities.

A study was set up in 2021 in England as a first step in finding out if self-sampling could be offered as an alternative option alongside the traditional clinician-taken cervical screening test. This study, HPValidate, is collecting 5,000 samples from general practice and 1,750 samples from colposcopy clinics to determine the accuracy of vaginal self-samples compared to clinician-taken samples. HPValidate is expected to report its final results early in 2024.

 

2.     Welsh Parliament action

In October 2023 the Welsh Government responded to a written question asking about any plans to include at-home smear tests as part of the current cervical cancer screening program in Wales.

In 2023 the Senedd’s Health and Social Care Committee conducted an inquiry into gynaecological cancers, which included consideration of self-sampling for cervical cancers. Public Health Wales told the Committee that recommendations from the UK National Screening Committee (NSC) on self-sampling (following the trials) will be considered by the Wales Screening Committee when available, and Cervical Screening Wales will be guided by the outcome of these to inform any changes to the programme. The Committee concluded:

Self-sampling is an exciting development that may help address some of the reasons for not attending cervical screening appointments, such as embarrassment. We look forward to the results of the pilot studies in England and welcome the Minister’s commitment to support the introduction of self-sampling in Wales, if the process is validated. However, the Welsh Government must act now to ensure the NHS is set up and ready to roll this out as quickly as possible, if approved. […]

Recommendation 10. The Welsh Government should, in its response to this report, outline what work is being undertaken to ensure that NHS Wales is set up to implement self-sampling at pace, if approved. This should include details of any redirection of resources that might be necessary

The Welsh Government responded to its report in March 2024.

 

3.     Welsh Government response

The Welsh Government says that like the rest of the UK, it follows the expert advice from the UK NSC on screening matters.

The UK NSC is yet to make a recommendation on self-sampling for cervical screening and there is a lot more work to do before it can be implemented. In 2019 the Committee issued a call for more evidence into the use of self-sampling in cervical screening. The Committee is currently considering the available evidence and there are plans for an in-service evaluation that will provide the UK NSC with real world evidence on the effectiveness of offering HPV self-sampling in cervical screening.

The Welsh Government describes this as a very promising development but says before self-sampling can be implemented, we need to ensure that it is safe and effective at detecting HPV, as any reduction in the test accuracy could outweigh the benefits of better access and put people at greater risk. “Our approach will be to wait for these findings and any subsequent UK NSC recommendation”.

 

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