The majority of women who develop cervical cancer have not been adequately screened, while one in five should have had their cancer diagnosed earlier or prevented, a review into New Zealand’s national screening programme has found.

Lack of access to regular screening remains the most common factor associated with the occurrence of cervical cancer, says the study’s prime investigator, Otago University associate professor Peter Sykes.

There were 644 women, aged 25 to 69, who were diagnosed with human papillomavirus (HPV) related cancers between 2008 and 2012.

Of those, just 13 percent had been screened according to the current National Cervical Screening Programme (NCSP) guidelines, which is to have a smear test every three years exactly. The proportion was even lower among Māori and Pasifika and those from lower socioeconomic groups.

The review also showed that just over a third of women (37 per cent) who developed cervical cancer had had a screen within the three-year screening period prior to their cancer diagnosis.

Meanwhile there were 128 women who had an abnormal screen in the six to 84 months prior to diagnosis, yet still went on to develop cancer. That represents almost 20 percent of women with cancer in that 25-69 age group.

“In an ideal world what should have happened was that those women should have had further investigation, and treatment, so the cancer would never have occurred,” says Dr Sykes.

“So something has gone wrong in the pathway to prevention, for those women.”

A range of things could be the reason for these cancers, he adds, and it would be useful to explore those factors in more depth.

“Some of those women will have had the smear and not turned up for further investigation, some will have turned up for further investigation but not for treatment that has been recommended, some of them will have had treatment but the treatment didn’t work, some will have had treatment but not the appropriate follow up.”

Emphasis should also continue to be placed on regular screening, especially for Māori and women from socially deprived areas.

The proportion of Māori and Pasifika women/wahine who were adequately screened was low (six per cent and five per cent respectively) and less than that of European or Asian women (18 per cent and 11 per cent).

Nest testing ‘positive change’

The plan to change to HPV primary testing later this year should be a “positive change and should hopefully markedly reduce” the number of cervical cancers, says Dr Sykes, provided that best practice follow-up and management is also in place.

HPV primary screening involves testing a cervical screen sample for the presence of an HPV infection. Nearly all cervical cancers are caused by genital infection with HPV.

According to the Ministry of Health, HPV primary screening is safer, but requires less frequent screening (every five years instead of three).

There is also the possibility of HPV self-sampling, and this could encourage Māori wahine to engage with the screening programme, says Dr Sykes.

“There is a clear need for renewed effort and novel approaches to the prevention of cervical cancer in Māori women/wahine. Fortunately, HPV vaccination in particular, as well as the option of HPV self-sampling may offer real opportunities to reduce these disparities.”

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