Around three thousand New Zealanders are being given the opportunity to take part in a new study where they can choose to test themselves for cervical cancer at either their doctor’s surgery or in the comfort of their own home.
They’re part of a new University of Otago, Christchurch-led, pilot study, backed by Te Whatu Ora’s National Screening Programme, to test the safety and efficacy of the newly-adopted Human Papillomavirus (HPV) test which is being rolled out as the principal screening test for cervical cancer in Aotearoa New Zealand from next year.
Trial Principal Investigator and consultant obstetrician Associate Professor Peter Sykes from the University of Otago, Christchurch’s, Department of Obstetrics, says there’s been an enthusiastic uptake so far, with over 900 people already signed onto the pilot study. He says participants are being recruited from 17 GP clinics and hospitals in the Canterbury, Whanganui and Capital and Coast regions.
“The main aim of the pilot is to identify any issues that may arise with the new HPV test programme before it’s rolled out more widely from next year. It will rigorously examine all parts of the screening pathway, from the invitation to take part, the choice of either at-home or in-clinic testing, right through to how well test results are communicated and whether any follow-up treatments are required and then sufficiently actioned.”
People eligible to take part in this pilot study will be contacted by or on behalf of their regular GP clinic. Participants will be given the choice of carrying out the HPV test on themselves at either the GP clinic or at home, or ask their smear-taker to perform a traditional cervical smear test on them instead.
Associate Professor Sykes says the Otago trial is one of three ongoing pilot studies into HPV screening, but the first to offer all these options.
“It will give people more choice and control over the process, which it’s hoped, will lead to a rise in the numbers taking part in the screening programme overall. While most people do have regular smears, some are put off by the invasiveness and discomfort of the current test, the anxiety it can cause, plus the fact it’s not always convenient to access a doctor or nurse to get it done. Carrying out the HPV test on oneself will be empowering, plus takes away some of this embarrassment, anxiety and inconvenience.”
Associate Professor Sykes says the HPV test is much less invasive than the traditional smear test, with no speculum required. The person simply collects a sample from the vagina using a single cotton swab.
“The clinician-taken test and the self-test are equally accurate, with the HPV test shown in a number of randomised clinical trials to offer greater sensitivity for the detection of pre-cancerous abnormalities and therefore a greater protection against cervical cancer. What’s more, because it’s so sensitive it also allows a longer interval between tests.”
If the HPV test is positive, further tests can be performed on the clinician-taken test while those who have taken a self-test may need to return to their smear-taker to have a sample taken from the cervix to determine if they need to go to the hospital for further tests.
Cervical cancer is an almost entirely preventable disease, yet despite the success of the National Cervical Screening Programme 170 New Zealanders are still diagnosed with it each year, resulting in 50 deaths. A review of the screening histories of those diagnosed with cervical cancer from 2008-2012 revealed that around half had not had a smear test in the 5 years prior to diagnosis.
The rates for Māori and Pasifika are significantly higher than for non-Māori and non-Pasifika; cervical cancer incidence per 100,000 people in 2017 was 9.7 for Māori, 6.1 for Pasifika, 5.5 for Asian and 5.7 for people identifying as European/other.
Associate Professor Sykes and colleagues recently completed the 2008-2017 Case Review of Cervical Cancer which found that Māori and Pasifika are more likely to experience barriers to cervical screening prior to their cervical cancer diagnosis when compared to other groups.
“Sadly, chief among these barriers are economic considerations as well as cultural considerations including difficulty building trust and relationships, and a reluctance to undergo a speculum exam. There’s evidence that self-sample is more acceptable for Māori patients than a speculum exam and that the use of self-sampling can, with an appropriate approach from health services, lead to a marked improvement in screening participation.
“We also know that right now, one contributor to screening failure is a delayed or inadequate response to an abnormal smear test, including delayed access to follow-on specialist assessment. The new HPV screening test is expected to identify more patients with cervical abnormalities than current smear tests, increasing demand on follow-up investigations and treatment. An important focus of our pilot study therefore will be documenting patient access to cytology triage and colposcopy and the potential impact this would have on future colposcopy services,” Associate Professor Sykes says.
For more information please contact:
Lorelei Mason
Communications Advisor
University of Otago, Christchurch
Mobile: +64 21 555 024
Email: lorelei.mason@otago.ac.nz
Issue 2
Ko taku māma taku kai, taku parenga me tōku kāinga – mehemea kai te pai a ia, kai te pai ahau
My māma is my nutrition, my protection, and my home – if she is well, I am well.
The Best Start Early Pregnancy Assessment funded by an HRC DHB Collaborative Research Grant
This second of our quarterly newsletters outlines the progress of the Best Start Research project.
Modules 1 and 2 have been running parallel and similar issues related to early pregnancy assessment were identified from the two perspectives of the Hapū Māmā Village insights (Module 1) and the initial Clinical Practice team (Module 2).
Technological issues related to the Best Start Tool for the Clinical Team were noted, however most of these were resolved by awareness that the form could be re-opened, and additional data added or updated.
Module 1 Hapū Māmā Village
Hapū Māmā Village is the co-design activity led by Prevention Partner Healthy Families, where hapū māmā stories and journey through pregnancy mapping expressed the experiences at a series of hui. In addition, the Team met with a variety of health professionals working with hapū māmā. From these hui key themes were developed. Extensive data has been collected by the Hapū Māmā Village team from hapū māmā and health professionals. Many general comments were similar specifically with regard to the systemic and structural inadequacies of the current health system in supporting pregnant women in the primary health care sector.
To date, some of the issues identified include trust, communication, lack of reliable information, maternal mental health, lack of knowledge about the GP's role in early pregnancy, problems with referrals, inability to find a lead maternity carer (LMC Midwife), lack of antenatal and birthing education. The Hapū Māmā Village team are currently collating the vast amount of information gathered so that Insights can be published, alongside research evidence found and recommendations made.
The Team kept the Research Collaborative informed throughout of progress and a final 'walk through' of all the raw data was held with the opportunity for one-to-one questions and answers.
Module 2 Clinical Team
The Clinical Team at the lead research practice Gonville Health has been engaged in the initial stage of the research and has identified a number of clinical practice issues.
Clinical issues to date have included:
Systemic
- inconsistencies arising from the current
- system incomplete recordings
- inconsistent follow up processes
- minimal liaison with LMC midwives
- lack of access to shared maternity care records
- unstructured processes around early pregnancy care
- variable identification of clinical risk variable use of referral options
- insufficient time within 15 min GP appointment
- current structure of GP clinical visits is not meeting the needs of many hapū māmā
Medical
- STI/UTI management in pregnancy
- Iron deficiency management
- Cardiac including arrhythmias/palpitations; murmurs
- Hypothyroidism
- Cholelithiasis
- Tuberculosis contact
- Epilepsy
- Current alcohol or drug misuse/ dependency
- Depression and anxiety disorders
- Asthma
- Acute respiratory conditions including Influenza-like illness, Hepatitis B, low immunity
- Previous SUDI (Sudden unexplained death of an infant)
Postnatal
- Postnatal depression - need clarity for screening tools and diagnostic criteria
- Management of minor neonatal abnormalities
- Maternal medication with risk to pēpī
Smoking cessation support
- Close liaison with Stop Smoking Services
Clinical Team responses to date
- Dedicated Nurse Practitioner lead/pregnancy care coordination
- Safeguarded appointment times
- Option of minimum brief assessment with virtual follow up
- Default ‘warm handover’ during Best Start appointments to health coach
- Upload option for pregnancy data to Clinical Portal for LMC midwife access
- Clinical issues peer meetings
The value of appointing a dedicated Nurse Practitioner, a Health Information Profession and/or a counsellor was evident and has enhanced the care of hapū māmā at the Clinic.
Module 3
The Wrap Around module explores the support for any pregnancy wellbeing services that exist in the community. There are a number of excellent services offered but the referrals appear ad hoc and engagement with health services unstructured. Work is continuing on this module so that pregnancy related risk referrals, management and equity gaps can be addressed via appropriate pathways of care.
