A project to understand the barriers to screening for a preventable cancer and to encourage women in the most deprived parts of Scotland to take part in cervical screening by self-testing has been awarded £1.3million.
University of Aberdeen researchers will lead the Cancer Research UK-funded initiative to find new ways of reaching women least likely to engage with cervical screening and who are at the greatest risk of dying from cervical cancer.
Cervical cancer is a largely preventable cancer and since 2008 girls aged 11-13 have been eligible for the human papillomavirus (HPV) vaccine which protects against around 90% of cervical cancers, with boys eligible for the vaccine, which can also protect boys from other HPV related cancers such as mouth and throat cancers, since 2019.
Cervical screening remains an important way to help to prevent the disease, particularly in those who didn’t receive the vaccination in childhood.
However, cervical screening is still important for all those eligible to detect pre-cancerous cells and enable treatment before they develop further.
Data from Public Health Scotland has shown that women in the most deprived areas of Scotland are twice as likely as those in more affluent areas to develop the disease and three times more likely to die from it.
Many of these women do not engage with screening and the project, called ‘AYEScreen’ will explore the reasons why - from lack of time or childcare, to fear, embarrassment or cultural and social barriers.
This will then inform a trial where women will be provided with self-sampling kits which will allow them to conduct the tests at a time and place of their choosing, and without the need for a medical professional.
Dr Sharon Hanley, a cancer epidemiologist at the University of Aberdeen, will lead the project.
She said: “Cervical cancer is different from many cancers in that it can be detected and treated in the pre-cancerous stage. This is why getting screened regularly is so important. However, since the screening programme targets healthy individuals, many women may not feel the need to attend or for what might be an embarrassing or uncomfortable test.
“In recent years the test has changed. In the past it was necessary to take samples from a specific part of the cervix to look for abnormal cells, now we look for the virus that causes these abnormal cells and the virus can be found in vaginal samples. This makes self-sampling possible. However, more research is needed on the best way to offer self-sampling.
“We would also like to include trans-men in the study as they are historically underserved and might be more willing to participate in self-sampling than attend for a test by a medical professional.”
The project will assess the effectiveness and cost efficiency of three different methods to reach under screened women in GP practices with the highest proportion of patients from deprived areas as well as those living in remote and rural areas who may have other barriers to testing such as access.
The first method will see women who are overdue screening and attend the GP surgery for another reason offered a self-sampling kit, the second will trial a text service offering self-sampling which can be returned by post and in the third, a nurse will call women to understand barriers to screening and offer the option of self-sampling, which will also be sent and returned by post.
It is hoped AYEScreen will provide the much-needed evidence base to inform future (Scottish) Government policy and that a nation-wide roll out of self-sampling for under screened women be implemented alongside the current screening programme.
“AYEScreen is about empowering those most marginalised in society to make informed choices, including those who could face discrimination and are disproportionately disadvantaged, and help protect them from a highly preventable cancer,” Dr Hanley added.
Cancer Research UK Senior Heath Information Manager, Claire Knight, said: “We are delighted to provide funding for this vital research. Cervical screening is a proven way to prevent cancer and stop the disease in its tracks. But some people face barriers to accessing the potentially life-saving test, like finding the test painful or embarrassing, and trials like this bring us closer to ensuring that everyone can benefit from screening health interventions.
“By offering an alternative to the standard GP appointment for people who haven't taken up their invitation, self-sampling may help to address some of these barriers, and in turn tackle health inequalities.
“If coverage of cervical screening and HPV vaccination increases, it’s possible that we can reduce cervical cancer to the point where almost no one develops it. Further research is now needed to better understand the accuracy of self-sampling and how it can be effectively rolled out to benefit more people.”