Self-sampling kits in GP visits boost cervical cancer screening

Women who are overdue for cervical cancer screening are most likely to participate in screening when a self-sampling kit is offered by a healthcare professional as part of routine GP appointments, according to a new study led by Queen Mary University of London with King’s College London.

Over half of the people offered an at-home test during an unrelated GP appointment returned the sample. If this approach were adopted across the NHS, it is estimated that as many as 1,0001 women would be prevented from developing cervical cancer every year. 

Home-testing kits for HPV will soon be offered to people in England who are overdue for cervical cancer screening, giving women and people with a cervix the option to stay up to date with cervical screening without having to have an internal examination. 

“We already knew that many women preferred using a self-sampling kit, rather than visiting their GP for a cervical smear test. But we didn’t know whether the way this option was presented would make a difference to how many samples were returned for testing. We studied women who were overdue their cervical screening. We compared sending a letter offering a kit, a kit in the post, or handing a kit to eligible patients if they came to see their GP or a nurse for another reason.” 

Peter Sasieni, Study Senior Researcher and Professor, Queen Mary University of London 

The study set out to answer this question by recruiting 13 GP practices in west London. These practices were randomly divided into two groups, with approximately 6000 women who were overdue screening in each group. One group of GP practices made in-person kit offers to women who were at least 6 months overdue for their cervical screening, the other group did not.

For the first group, when women attended their GP practice for any reason, their doctor or nurse was encouraged to offer them a self-sampling kit. In the study, each month people who were 15 months overdue for cervical screening were randomised. Half received no special communication, a quarter were mailed a self-sampling kit, and a quarter were sent a letter offering a kit. 

“Our study showed that offering a self-sample kit in person was the most effective method of encouraging women to complete their cervical cancer screening tests: of 449 women opportunistically offered a kit in a GP appointment, 234 (52%) accepted and returned a sample,” confirmed Professor Sasieni. “The uptake of self-sampling after a postal offer was lower: 12% among those sent a kit, and just 5% for women sent a letter offering a kit. But since letter and kits were sent regardless of whether women consulted with their GP and regardless of how busy their GP practice was, in total more women were screened thanks to the systematic offer at 15 months than the opportunistic offer in the GP practice. This shows that a combination of approaches may be best for enabling more women to participate in cervical screening.” 

“Cervical cancer is the most preventable of cancers. Women born before 1990 will not benefit from HPV vaccination. But they can reduce their risk by 80-90% if they get screened regularly.” 

Dr Anita Lim, Lead Epidemiologist on the study and Chief Investigator of the YouScreen trial from King’s College London, said: “These findings are directly relevant to current efforts to modernise cervical screening in England. Self-sampling gives women greater control over how and when they get screened. In the YouScreen trial, we saw how effective self-sampling can be in reaching women overdue for screening. This study reinforces that many women welcome the option – particularly when it’s offered in person by a trusted healthcare professional. A simple change like this could have a major impact on preventing cervical cancer.” 

Fiona Osgun, head of health information at Cancer Research UK, said: “Cervical screening can prevent cervical cancer, but we know that almost a third of people in the UK tell us they are overdue their appointment – whether that’s due to discomfort, embarrassment, or simply struggling for time. 

“That’s why we welcomed the government’s decision last month to roll out cervical home screening kits in England for people who don’t take up their invite. This study shows that offering these kits during GP appointments could be part of an effective approach to making screening more accessible and remove barriers. Beating cervical cancer means beating it for everyone, and research like this is vital to help bring us closer to that goal. 

“It’s important to remember that cervical screening is for people without symptoms so, if you notice any unusual changes for you, don’t wait for a screening invitation – speak to your doctor.” 

For medical systems where GPs act as the front door to health care – such as the UK and Australia – the researchers suggest that offering a self-sampling kit during an appointment would be an effective way of encouraging more women to participate in cervical screening. 

3300 women are diagnosed with cervical cancer each year in the UK. It has been estimated that that number would be 5000 higher if it weren’t for cervical screening. In the past, 80% of women participated in cervical screening, but that number has been falling. In 2024 only 66% of those eligible for screening were up to date. 

Vaccinating adolescents against the human papillomavirus (HPV) is extremely effective at preventing cervical cancer. But the vaccine is less effective if given at older ages. The best way to prevent cervical cancer in those not vaccinated when they were young is through screening. Regular screening reduces the risk of getting a cervical cancer by about 80%.