New research from scientists at the University of Manchester has revealed urine tests could help prevent cervical cancer. With women taking up smear test invitations at a 20-year low, could new advances save women's lives?

If you’re over 25 and you have a cervix, the chances are, you’ve at least fleetingly thought about skipping out on your smear test. It’s uncomfortable, embarrassing, and trying to book an appointment outside of working hours? Don’t even get me started. At 29, I’m somewhat ashamed to admit I’ve been dodging my own GP letters for the past four years.

Each day, two women lose their lives to cervical cancer. Nine new women are diagnosed each day. Yet 75% of all cases of cervical cancer could be prevented if more women were to take up the five-minute cervical screening.

With scientists working on new ways to help us get past our fears, embarrassment, and inconvenience with the help of technological leaps forward, could pre-cancer cervical screening soon become even more accessible for those of us in England?

New research reveals urine testing may be as effective as smear tests in preventing cervical cancer

New research released by the University of Manchester has unveiled positive results. Trialing urine testing for human papillomavirus (HPV), the cause of approximately 70% of cervical cancers, The study, led by Dr Emma Crosbie was published within the BMJ Open in early April. Results revealed that urine testing could be as effective as cervical smear tests currently used to detect high-risk HPV.

Researchers hope that the introduction of urine tests could be able to increase the number of women who chose to take up their invitation to be screened for cervical cancer. Over 3,000 women each year are affected by cervical cancer, yet the number of women taking up their GP’s invite for screening every three to five years has fallen to a 20-year low.

Researchers hope that the development of alternative tests such as the urine test may also have positive impacts within developing countries, where cervical cancer can be up to 15 times more common due to a lack of smear testing options for women.

Dr Emma Crosbie shared her thoughts on their research.

“We’re really very excited by this study, which we think has the potential to significantly increase participation rates for cervical cancer screening in a key demographic group. Many younger women avoid the NHS cervical cancer screening programme because they find it embarrassing or uncomfortable, particularly if they have gynaecological conditions like endometriosis.

“Campaigns to encourage women to attend cervical screening have helped. But sadly, the effects aren’t long lasting and participation rates tend to fall back after a while. We clearly need a more sustainable solution.”

While previous campaigns such as that run by the late Jade Goody have increased awareness and encouraged as many as half a million more women to attend screening appointments, research has shown that these effects do not last. At its peak, attendance for smear tests rose by 70% between 2008-09 thanks to headlines surrounding Jade Goody’s campaign and experience with cervical cancer, however increased levels of participation were not sustained. Alternative methods to encourage women to seek early screening, such as urine testing, are hoped to be more sustainable.

Over 100 women took part in the research led by Dr Crosbie at St. Mary’s Hospital, Manchester. Women were screened using two brands of HPV testing kits. Two-thirds of the women tested positive for any high-risk HPV type, with a third testing positive for HPV-16 or HPV-18 (two of the highest-risk types of HPV, of which cause the most cases of cervical cancer).

18 women had pre-cancerous changes to their cervix which needed treatment. Of the two urine testing kits used, the Roche HPV testing kit (urine, vaginal self-samples, and cervical smears) picked up 15 of these cases. The Abbott HPV testing kit (urine) picked up 15 cases, while the vaginal self samples and cervical smears picked up 16 cases.

Further trials on larger numbers of women are still needed before such tests could be considered for use by the NHS, however, researchers are encouraged by these early results. According to the team running the trial, cervical smear samples, urine samples, and self-collected vaginal samples are all effective at identifying high risk HPV.

In March 2019, a pilot was announced for North and East London this coming September. A DIY smear test will be made available to women in participating areas, giving women the chance to test themselves at home in what has been called a potential “game-changer” by Jo’s Cervical Cancer Trust.

Women from participating surgeries who are at least six months overdue for their test will be invited to take part in the pilot. Aiming to discover how feasible an at-home option would be for women across England who have not taken up invitations for screenings, the pilot (commissioned by the NHS) is being run in collaboration between King’s College London and the University College London Hospitals Cancer Collaborative. Women who have trialled the home-testing kit have previously compared it to using a tampon, taking just a few minutes to collect the sample.

What are smear tests and why are they important?

Smear tests save lives. According to The Eve Appeal, each year, over 21,000 new gynaecological cancer cases affect women across the UK. There’s a simple test that can catch around 75% of cervical cancers, in some cases years before the cells are able to develop into cancer. It only takes about five minutes, yet according to the latest NHS figures, fewer and fewer of us are taking up our free screening appointments.

Most commonly occurring in women aged 30-35, smear tests can help detect precancerous cells as far as 10 years before they can develop into cervical cancer., yet just 71% of women aged 25-65 are attending our appointments.

Women aged 25-49 should be tested every three years, while women aged 50-65 should be screened every five years. While the NHS would like at least 80% of women to take up their screening invitations, in London just 64% of eligible women invited were screened in 2018, with figures dropping below 50% in some areas. That’s the lowest the update has been in over two decades.

Smear tests can help detect abnormal cells within your cervix. Removing these cells can prevent cervical cancer. Most commonly affecting sexually active women aged 30-45 (as HPV can be transmitted during sex), approximately one in 20 women show signs of abnormal changes to cells around their cervix.

Appointments typically take five to 10 minutes, with results available approximately two weeks after your appointment. Usually conducted by a female nurse or doctor, if you feel uncomfortable at any time or would like to request a different medical professional you can ask them to stop at any time.

Current methods to check for cervical cancer use a speculum and small brush to collect cells from your cervix. These are then tested for any abnormalities. While the procedure can be uncomfortable and unpleasant, for many women it is quick and pain-free. Some women with certain medical conditions such as endometriosis (a painful disorder that means tissue that would normally line your uterus grows outside of these areas) as well as those who have gone through the menopause can find smear tests to be more uncomfortable than others.

Why are we avoiding our smear tests?

It’s the big question: we know how effective smear tests can be for detecting early pre-cancerous cells, yet one in four of us avoid them. Screening is thought to save around 5,000 lives every year and could save even more if we all attended our appointments. What’s stopping us?

Research has suggested a number of reasons could be holding us back from getting our check-ups. Anxiety, embarrassment, and lack of knowledge are thought to be three significant barriers.

According to research from Jo’s Cervical Cancer Trust, over a quarter of young women age 25-29 feel too embarrassed to go, while two-thirds don’t believe the test will reduce their risk of cervical cancer. Fear that tests may be painful also stop women of all ages, particularly those over 50 or who have gone through the menopause, from taking up their appointments.

For women who have experienced sexual assault or genital mutilation (FMG), smear tests can be distressing or intimidating. Other women may have trouble making time for appointments due to working hours or childcare challenges, while female to male transgender men or nonbinary individuals with a cervix may not realise the importance of continuing to have regular check-ups.

In some areas, childcare providers have taken to offering parents a free hour of childcare to allow women to attend cervical screening appointments.

Charity Jo’s Cervical Cancer Trust looked into the barriers holding us back from screening. Their research revealed that black, Asian minority and ethnic (BAME) women are a third more likely than Caucasian women to have never attended a cervical screening, while 30% of Asian women asked didn’t know what cervical screening is compared to just 14% of Caucasian women. BAME women also revealed that they felt less comfortable talking to their male GP about cervical screening, with only 28% saying they would be comfortable speaking with them compared to 46% of Caucasian women.

Research also revealed that women with learning disabilities are significantly less likely to get a smear test. Average attendance across the UK is just under 78%, yet for women with learning disabilities, this falls to between just 13-25%.

For some women, they may be unaware that they should still be having a smear test despite having had the HPV vaccine. Others may mistakenly think that if they have only had one sexual partner, haven’t had sex for a long time, or have had a partial hysterectomy, that they are at a lower risk. Everyone aged 25-65 with a cervix who has not had a full hysterectomy should have regular smear tests.

Having relevant information, understanding the risks, and feeling comfortable speaking to our health care providers are all highly important steps towards helping more of us feel comfortable in getting our smear tests.

While the future looks bright, with the potential for at-home self-testing kits and urine testing options on the horizon, in the meantime, traditional tests are widely our only option. If you are feeling nervous or worried about making an appointment, there are a few ways you can make the experience go a little more smoothly.

How to decrease your pre smear test nerves

Whether you have just received your letter, missed your last test, or have been dodging getting your smear for a while, the NHS encourages women to regularly get screened. If you are aged 25-49 and haven’t been tested in the last three years, or if you are aged 50-65 and haven’t been tested over the past five years, you can book an appointment without waiting for a letter.

Although they aren’t compulsory, cervical screening tests can help prevent up to 75% of cervical cancers. If you are feeling nervous or unsure if you want to go ahead with a smear test, remember: a lot of us feel anxious or embarrassed about having a cervical screening. It’s normal to feel nervous.

Speaking with the doctor or nurse before you begin can be a good way to help ease your nerves, as well as to give you the opportunity to ask any questions you may have before you begin. This also gives them the opportunity to take things slowly and explain things step-by-step, which can help ease your nerves as you go. If you have had an uncomfortable experience previously, talking things through with the nurse or doctor conducting your smear test can also provide reassurance, advice, and support.

Bringing someone with you can be another simple way to help ease your nerves and provide support during your test. Wearing loose fitting clothes you can easily lift or move, such as a skirt or dress can help you feel less anxious as this can be left on during your examination.

Worried about the potential results? Try to remember: smear tests look for cells that are showing abnormalities that, if untreated, may develop into cervical cancer over time. Over 90% of women tested have their results come back as normal. For those who do have abnormal results, these often can be treated and may not necessarily be a sign of cancer.

For more information on cervical screenings, how to book an appointment, and finding further help and support, visit the NHS online. To find out more about cervical cancer, HPV, and commonly asked questions about cervical screening, check out Jo’s Cervical Cancer Trust.

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