Home test for women who have not screened for cervical cancer

Cervical cancer is caused by HPV. Participation in cervical screening prevents cancer cases and mortality from the disease.

Screening is performed by pap smear every three years or HPV test every five years, and is performed by gynaecological examination, mainly by a doctor/GP.

The purpose is to uncover precancerous lesions that can be treated before it develops into cancer.

Women who do not check themselves have an increased risk of cervical cancer.  

Too low participation 

Approximately 17 % of Norwegian women between the ages of 35 and 69 have not participated in screening in the last ten years. The reason for the lack of participation may be fear of pain, embarrassment, previous negative experiences, or that the women postpone screening.    

The purpose of the study was to investigate whether home tests, a test that the women perform themselves, could increase participation among those who choose not to check themselves. 6 000 women from four counties in Norway who have not participated in screening in the last ten years participated in the study. They were randomized into three groups:  

• Group 1 received a standard reminder letter to take a cervical swab from a doctor  
• Group 2 received an offer to order a home test  
• Group 3 mottok unsolicited, directly sent home test    

The results showed that participation in screening increased most for those who received unsolicited, directly sent home tests, but it also increased for the other two groups.  

5 % of the women in group 1 who received a reminder to take a cervical swab followed the recommendation and took the sample from a doctor.

In group 2, 17 % of the women participated in screening, of which 4 % took the sample from a doctor and 13 % took the HPV home test.

In group 3, 27 % of the women participated in screening, of which 4 % took the cervical swab from a doctor and 23 % of the women took the HPV home test.  

Important to attend the follow-up test 

Women with a positive HPV test received an appointment for a follow-up test with a doctor or gynaecologist. Approximately 92 % of the women took a follow-up test from a doctor. In order for home testing to help improve cervical cancer prevention, it is very important that women attend follow-up.  

In the study, 11% of the women had a positive HPV test. In the screening programme otherwise, 5.6 % of women have a positive HPV test. Furthermore, 3.5 % of the women who participated in screening in the study were diagnosed with cervical dysplasia.

Among women who participate in regular screening, 1.2% of women have cervical dysplasia. This shows that women who have not had a cervical swab for 10 years or more have a greater risk of developing cervical cancer.

Increasing participation in screening among this group will have an important preventive effect. The average age of the study participants was 54 years. 

The study shows that home testing increased participation in screening compared to a reminder of a cervical swab by a doctor.

However, some of the women who had the opportunity for a home test chose to go to a doctor for screening. One should therefore maintain the possibility of screening by a doctor in addition to the possibility of home testing.