Sweden has a system of regular gynaecological smear tests, which has halved the number of cases of cervical cancer. Most of the patients who die from the disease are therefore either above the screening age, or part of the 20% who fail to attend their screenings. The figures are similar in other countries with equivalent screening programmes.
“We are usually able to cure cases of cancer that are identified through smear tests. For those women who have not been for smear tests, the cancer has progressed considerably further by the time it is diagnosed. It is these women who are at risk of dying from the disease”, says Dr Lotten Darlin at Lund University in Sweden.
The most common response when asked why they haven’t attended cervical smear tests is that the tests are unpleasant, that the women felt healthy and/or that they haven’t had time, according to one of Lotten Darlin’s studies. She therefore investigated the possibility of home testing, but the testing kits that are currently available have been shown to be either complicated or expensive.
Dr Darlin and her colleagues have therefore developed their own test, which comprises a simple cotton bud and a test tube. The test is sent off to a lab, where it has been shown to produce just as clear results as HPV tests taken by a doctor. HPV tests measure levels of human papilloma virus, a virus that in the long run can cause cervical cancer.
In one study, self-testing kits were sent to 1,000 women who had not had a smear test for over nine years. Fifteen per cent of them used the test and sent in samples for analysis.
“That may not seem like many. But for this group, who have failed to go for a smear test for so many years, it is nonetheless a significant improvement”, says Lotten Darlin.
She believes that the simple self-testing kit could also be used in countries that do not have a programme of regular cervical smear tests:
“It doesn’t require a lot of resources or a well-developed health care system to analyse the results. The women just need a basic knowledge of their bodies to take the test correctly.”
Other studies that Dr Darlin has conducted concern the end of the regular screening programme. The tests are discontinued at different ages in different parts of Sweden, but usually end between the ages of 60 and 65.
Lotten Darlin’s studies show that many cases of cervical cancer are diagnosed in women in their sixties – a quarter of cases after the age of 65. She thinks the health service therefore shouldn’t let older women leave the screening programme without a special exit test for HPV.
HPV stands for human papilloma virus, a virus that in the long run can cause cervical cancer. If an HPV test shows that a woman carries this virus, a smear test should be performed and possible treatment given. However, if the test shows that the virus is not present, then there is a minimal risk of the woman developing cervical cancer later in life.
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