HUMAN PAPILLOMAVIRUS (HPV) self-testing boosts cervical cancer screening rates, a 2026 cluster-randomised, non-inferiority trial has found.
HPV self-testing showed both non-inferiority and superiority over clinician-sampled Pap smear in New Zealand, with particular benefits for underscreened and marginalised populations.
HPV and Cervical Cancer
HPV testing is recommended for cervical cancer screening. Self-testing in this context increases uptake by underscreened women and people with a cervix.
Researchers assessed whether a universal offer of HPV self-testing at primary care practices would increase screening coverage compared with usual care.
Self-Testing Versus Usual Care
Researchers offered the HPV self-testing in 14 primary care practices in Te Tai Tokerau Northland, Aotearoa New Zealand, which were then assigned to the intervention (self-testing) or comparison (usual care) groups.
Women and people with a cervix aged approximately 25–70-years-old who were due or overdue for cervical screening and attending the participating practices were eligible to be included in the trial.
In the intervention group, the universal offer for HPV self-testing went alongside community engagement strategies, ongoing education, and the option to engage with clinician-sampled Pap smear if the self-test was declined.
Participants in the comparison group were offered usual care (a Pap smear).
Non-Inferiority and Superiority
More than 22,500 people were included in analysis, between 8th February 2022 and 8th September 2023.
The mean age was around 50-years-old and more than 9,700 participants were Māori.
In the intervention group, the mean proportion screened was 35.6%, significantly higher than in the comparison group, at 24.9%, over a period of 14–19 months.
The HPV self-testing showed, therefore, non-inferiority and superiority to current care.
Favourable Results for Underscreened and Marginalised Groups
In New Zealand, Māori women are twice as likely as non-Māori women to die from cervical cancer and are less likely to be screened.
Favourable results remained consistent across screening coverage for Māori people and non-Māori people.
It also led to increased screening among people who had never been screened, had not been screened in at least 4 years, or who were living in areas of medium or high deprivation, researchers reported.
Sensitivity analysis adjusting for age, ethnicity, deprivation index, and screening status confirmed robustness of findings.
Recommendations for Cervical Cancer Screening
Researchers recommended that, based on their findings, countries with organised cervical cancer screening programmes should consider implementing a universal offer of HPV self-testing.
This should increase screening coverage and reduce preventable morbidity and mortality from cervical cancer.
Reference
Lawton B et al. Primary cervical screening using a universal offer of human papillomavirus self-testing versus usual care in Aotearoa New Zealand: a cluster-randomised, non-inferiority trial. Lancet Obstet Gynaecol Women’s Health. 2026;DOI:10.1016/S3050-5038(25)00201-8.
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