Cervical cancer

Research

1. Cervical Screening by HPV Self-Testing: A Game Changer for Māori (opens on the publisher’s website)

   2024

   Bev Lawton, Anna Adcock, Kendall Stevenson, Tania Slater, Francesca Storey

   What it found

   The chapter sets out why HPV self-testing changes cervical screening for wahine Maori. It reports that 41% of wahine Maori are underscreened or never screened against 21% of European and other women, and that HPV-based screening gives 60 to 70 per cent greater protection than cytology. From the He Tapu Te Whare Tangata studies, underscreened wahine Maori offered an HPV self-test were almost three times more likely to be screened, and those more than ten years from their last screen almost five times as likely. It records that in September 2023 Aotearoa New Zealand became the first high-income country to move straight to HPV self-testing as the primary screening method.

   How it was done

   book chapter drawing on the He Tapu Te Whare Tangata research programme: qualitative interviewing, clinical implementation and randomised controlled trials

   Why it matters

   This is a documented case of Maori-led research changing a national screening programme, and it names the organisations whose advocacy contributed.

   What it does not settle

   A chapter summarising a research programme rather than a single study, so the figures quoted rest on the underlying papers it cites, two of which are separately in this collection.

   Full textfull text, supplied by Brooke from the publisher page (open access, CC BY-NC-ND 4.0)

2. Perceived barriers to self-collected HPV testing for cervical cancer screening, and knowledge of HPV: a survey of primary healthcare smear-takers across Aotearoa New Zealand (opens on the publisher’s website)

   2024

   What it found

   The survey measured primary-care smear-takers' knowledge of HPV and their views on the shift to primary HPV testing, including home self-testing. Average knowledge score was 56.5%, with strong understanding of some areas (comparability of self- versus clinician-collected samples) and weak understanding of others, including the new recall guidelines. Respondents mostly rated the anticipated logistical barriers to home self-testing as minor, but 73.3% wanted further education on managing results under the new programme.

   How it was done

   cross-sectional web-based questionnaire, 73 respondents (67 completed in full), 57.8% completion rate

   Why it matters

   The paper's own introduction notes that 2022 national cervical screening coverage sat at 78% for non-Māori against 62% for Māori, so gaps in provider knowledge about the new HPV self-testing pathway land on a workforce already serving an unequal screening system.

   What it does not settle

   This assessment covers only the first five pages of the PDF (abstract through early results); the paper's own stated limitations, further results and full discussion were not read and are not represented here. The study itself is a single-round survey with a 57.8% completion rate, self-reported knowledge, and predominantly NZ European respondents (72.6%), with only 12.3% identifying as Māori.

   Full text, in partfull text (first five pages of the PDF read directly: title, abstract, introduction, methods, and the start of results including demographic tables; the discussion and stated-limitations section further into the PDF was not read)

3. A Model for Empowering Rural Solutions for Cervical Cancer Prevention (He Tapu Te Whare Tangata): Protocol for a Cluster Randomized Crossover Trial (opens on the publisher’s website)

   JMIR Research Protocols · 2023

   Lawton B, MacDonald EJ, Storey F, Stanton JA, Adcock A, Gibson M, Parag V, Sparkes NK, Kaimoana B, King F, Terry M, Watson H, Bennett M, Lambert CS, Geller S, Paasi I, Hibma M, Sykes P, Hawkes D, Saville M

   What it found

   This is a protocol paper, not a results paper. It sets out a trial comparing two pathways after a positive HPV self-test: one giving a point-of-care result within an hour with immediate referral to colposcopy, run through community-controlled services, against standard laboratory-based testing and referral. The primary measure is the share of women who reach colposcopy within 20 working days. In the first 15-month period, 743 eligible self-tests were done, split roughly evenly between the two pathways, with 7.3% testing positive for high-risk HPV.

   How it was done

   trial protocol, cluster randomised crossover design, two rural primary care sites; interim uptake figures only (743 HPV self-tests over the first 15-month period)

   Why it matters

   If the community-controlled, point-of-care pathway shortens the wait to colposcopy, it is a concrete model for closing a step in the cervical screening pathway where delay disproportionately affects rural Māori women.

   What it does not settle

   Protocol and interim uptake data only; the primary outcome (colposcopy timeliness by pathway) was not yet reported at the point this paper was published.

   Full textfull text, read via PMC (PMC10540018)

   Read it free: A Model for Empowering Rural Solutions for Cervical Cancer Prevention (He Tapu Te Whare Tangata): Protocol for a Cluster Randomized Crossover Trial (opens on another organisation’s website)DOI 10.2196/51643

4. Acceptability of human papillomavirus (HPV) self-sampling among never- and under-screened Indigenous and other minority women: a randomised three-arm community trial in Aotearoa New Zealand (opens on the publisher’s website)

   2021

   Naomi Brewer, Karen Bartholomew, Jane Grant, Anna Maxwell, Georgina McPherson, Helen Wihongi, Collette Bromhead, Nina Scott, Sue Crengle, Sunia Foliaki, Chris Cunningham, Jeroen Douwes, John D Potter

   What it found

   Never-screened and markedly under-screened Maori, Pacific and Asian women aged 30 to 69 were randomised to take an HPV self-sample at their clinic, to be mailed a kit to use at home, or to usual care by cytology. Participation was highest in the mailed-to-home group: 14.6% of Maori women against 2.0% under usual care. Adjusted for study group, screening history, deprivation and age, Maori women sent a kit were 9.7 times more likely to be screened than those offered usual care (95% CI 3.0 to 31.5), Pacific women 6.0 times and Asian women 5.1 times. Of those who self-sampled, 7.9% tested positive for a high-risk HPV type, and clinically appropriate follow-up was completed for 92% of them, needing a mean of 2.5 hours of nurse time each.

   How it was done

   open-label three-arm randomised community trial, 3,553 women, with a non-randomised follow-on substudy

   Why it matters

   It shows the route that actually reaches the women the screening programme has never reached, and it puts a number on the follow-up workforce that route requires.

   What it does not settle

   The authors note they could not tell whether non-responders ever received the invitation, so participation may be underestimated; recruitment was limited to two Auckland districts, so the findings may not carry to rural areas; and participants and staff could not be blinded.

   Full textfull text, supplied by Brooke from the publisher page (open access)

5. Recommendations for implementing HPV Self-testing in Aotearoa (opens on the publisher’s website)

   2021

   What it found

   Written after the 2021 Budget announcement of funding for a national HPV self-testing programme, this editorial by researchers and health board staff who ran New Zealand's HPV self-testing trials sets out recommendations for the Ministry of Health's rollout. These include making Māori health equity the organising principle of implementation rather than an add-on, reviewing the legislation governing the national cervical screening programme to strengthen Māori governance over screening data, building risk-stratified and culturally safe colposcopy and follow-up pathways, and offering an on-request mailed self-test alongside clinic-based testing.

   How it was done

   editorial / expert recommendations, not a primary study

   Why it matters

   It put Māori governance over cervical screening data on the table as part of the implementation design, ahead of the 2023 national rollout of HPV self-testing.

   What it does not settle

   This is an editorial by the people who ran the underlying self-testing trials; several authors declare Health Research Council funding, pharmaceutical or diagnostics industry fees, or a seat on the National Screening Advisory Committee. It sets out recommendations rather than new data.

   Full textFull text, read directly from the NZMJ PDF (all pages, including author declarations and references)

In our library

Nothing in our own library is specific to cervical cancer. What we publish is mostly cross-cutting – annual reports, evaluations and reports that span the whole cancer pathway – and all of it is at Rauemi.