Nearly four million women in England who are not up to date with cervical screening are now being offered HPV self-testing kits in a major NHS expansion aimed at improving participation in the potentially life-saving programme.
The expansion comes as NHS figures show that just 68.8% of eligible women are up to date with cervical screening, well below the 80% target. It also comes against a backdrop of wider challenges in women’s healthcare. Research commissioned by the Royal College of Obstetricians and Gynaecologists (RCOG) found that only 36% of surveyed women considered accessing women’s health services easy, compared with 46% who found it difficult.
Additionally, research from AXA Health revealed that 16% of women have avoided a cervical screening appointment altogether. This figure rises to 20% among Gen Z women, compared with 13% of Boomers. Among those who avoided screening, 46% cited concern that the procedure would be uncomfortable or painful, 36% reported anxiety or worry, and 30% cited embarrassment about undressing. The research also found that 49% considered showering or washing before an appointment, highlighting the significant anxiety surrounding intimate healthcare.
The new self-testing programme targets eligible women aged 30–65 who have not attended screening following previous invitations. Invited individuals can order a free kit through the NHS App or NHS online account. The kit contains a swab for collecting a vaginal sample at home, which is then returned to the NHS to test for high-risk human papillomavirus (HPV).
The home test does not directly diagnose cervical cancer. If high-risk HPV is detected, the woman will be invited for appropriate follow-up with a healthcare professional. Evidence from the YouScreen trial indicates that offering HPV self-sampling could increase participation, with NHS England estimating that the approach could result in around 400,000 additional women being screened annually.
For Olivia Wickens, Associate Medical Director at Panthera Clinic, the initiative highlights an important change in addressing screening challenges. “A screening programme can only be effective in protecting people if they understand its benefits and are able and willing to take part,” Wickens said. “When almost half of women in research say accessing women’s health services is difficult, and other research shows that discomfort, anxiety, and embarrassment can all play a role in avoiding cervical screening, it is understandable why alternative ways of accessing screening are being explored.”
“Home HPV self-testing doesn’t remove the importance of cervical screening or replace the need for clinical follow-up,” Wickens added. “But for some women, being able to take that first step privately at home could remove a significant practical or emotional barrier and help improve engagement with screening.”
7 ways to make in-clinic cervical screening easier
While home testing removes certain barriers, women continuing with clinician-led screening should know that, while a smear test might be slightly uncomfortable, it should be painless when relaxed. According to Wickens, there are several practical steps women can discuss with their clinician before or during an examination
- Tell your clinician what you are worried about: “Don’t feel that you have to hide your anxiety or worries,” Wickens said. “Telling the nurse or doctor before the examination starts can give them the opportunity to fully explain what they’re doing, slow down, provide any reassurance, and make any adjustments where appropriate to help you feel as relaxed and at ease as possible.”
- Ask whether a smaller speculum could be used: “If discomfort is your main concern, you can ask whether a smaller speculum would be suitable. It’s a simple question, but one many women may not realise they can ask, and different speculum sizes are available.”
- Ask about changing positions for comfort: “There isn’t necessarily one position that works best for everyone. If you find the usual positioning uncomfortable, ask whether there is an alternative position that could be considered that might make you feel more relaxed,” Wickens explained. “Breathing techniques can also be a useful tool to help you feel more relaxed.”
- Ask for more time if you need it: “If you’re feeling particularly anxious, ask whether a longer appointment is possible. Having additional time can give you the opportunity to discuss concerns before the examination begins, rather than feeling rushed once the appointment starts.”
- Take someone with you or ask for a chaperone: “If having someone you trust nearby would make you feel more comfortable, ask the practice about your options. You are also able to request a chaperone.”
- Agree on a stop signal before starting: “This is one of the simplest ways to make the appointment feel more within your control,” Wickens added. “Before the examination begins, agree that if you say ‘stop’, the clinician will stop. You do not need to wait until the examination is over to say that something is uncomfortable.”
- Talk about previous difficult experiences: “If you have experienced pain, trauma, or a particularly difficult cervical screening appointment in the past, you can tell your clinician. You don’t necessarily have to provide details. Simply explaining that you have had a difficult experience before can help the clinician understand why you may need more time, reassurance, or adjustments.”
Long-term strategy for cancer elimination
The NHS has set an ambition to eliminate cervical cancer in England by 2040. “The aim shouldn’t be to replace one form of screening with another for everyone. It should be to give women safe, appropriate options that make it easier for them to participate,” Wickens added. “If taking the first stage of testing into the home means reaching women who have previously missed screening, that could have a meaningful impact on participation and, ultimately, on cervical cancer prevention. The opportunity now is to make sure that the women who have been hardest to reach are the ones who benefit most from this new approach.”
Women should continue to attend cervical screening when invited, including those who have received the HPV vaccination, as the vaccine does not protect against every type of HPV that can cause cervical cancer.