From November, GP practices across North Central and North East London will be given the unique opportunity to take part in the YouScreen study offering HPV self-sampling to non-attenders within the NHS Cervical Screening Programme (NHS CSP). YouScreen will integrate self-sampling into the NHS CSP for the first time and will help provide the evidence base for a new innovation in cervical screening.
London consistently has the lowest cervical screening coverage nationally (65.6% versus 72.6% across England in 2018/2019). All GP Practices across Barnet, Camden, Islington, Newham and Tower Hamlets, which are all areas with particularly low cervical screening coverage, will be offered this exciting opportunity to increase their practice’s coverage.
What is HPV self-sampling?
HPV self-sampling is when women collect their own sample for cervical screening using a vaginal swab. Self-samples are then analysed for the presence of human papillomavirus (HPV) and have similar accuracy to clinician taken samples.
Self-sampling has been hailed as a ‘game-changer’ for cervical screening because it addresses most screening barriers by enabling women to take their own vaginal sample, in private and at a time and place of their choosing (similar to chlamydia self-sampling).
For more information on what the YouScreen study will involve for participating GP practices and patients, please download the YouScreen GP Booklet.
What are the aims of YouScreen?
- To test a new pathway for the implementation of self-sampling for non-attenders within the NHS cervical screening programme in England
- To provide the evidence-base that self-sampling can improve cervical screening coverage in England and can increase the detection and treatment of high grade CIN (CIN2+)
How will YouScreen self-sampling kits be offered?
The target population is women aged 25-64 years who are non-attenders i.e. at least 6 months overdue cervical screening. Eligible women from participating practices will be identified and offered self-sampling kits via two different methods:
- Opportunistic offer: women who are at least 6 months overdue their cervical screening according to their GP records will be identified via an EMIS alert and offered a kit by a healthcare professional when they consult for any reason
- Direct Mail-out: participating practices will not need to do anything; kits will be posted by a mailout company. Eligible women registered at your practice will be identified via the national cervical screening database NHAIS and posted a kit to their home address when they reach the 15month anniversary of their last test due date without being screened.
How can my practice take part?
All GP Practices in Barnet, Camden, Islington, Newham and Tower Hamlets will be invited to register interest from 28th August 2020. Your primary care cancer leads and CCG will email the practice with the necessary information which will include a link to an online Expression of Interest Survey that will need to be completed by 18th September 2020. You will only need to submit the expression of interest survey once for your practice.
If a very high response rate is received from GP Practices, it may be necessary to give your practice a set time frame for when the self-sampling kits can be offered. This is so all practices are given the opportunity to participate.
Once you return the expression of interest survey, the YouScreen study team will be in contact over the following months to arrange a 30 minute virtual training session and begin setting up your practice. The YouScreen Team plan to roll out the study across the 5 London boroughs gradually from November 2020.
Who is organising the YouScreen study?
The YouScreen study is led by King’s College London in partnership with:
- The North Central London Cancer Alliance
- The North East London Cancer Alliance
- NHS England / Improvement
- NHS Digital
- University College London
- Cancer Research UK & King’s College London Cancer Prevention Trials Unit
- Public Heath England
- Jo’s Cervical Cancer Trust
Question and Answers
Meta-analysis shows that HPV testing on self-collected samples is at least as sensitive as good quality cytology on clinician samples (Arbyn et al, Lancet Oncol, 2014). Therefore, in England self-sampling with HPV testing would not be an inferior test to clinician-collected cytology.
- Women who test HPV negative (vast majority ~85%) will be invited at the next screening round according to their age (next test due date will be reset in the national cervical screening (call/recall) programme).
- Women who test HPV positive (~15%) will be advised in their results letter to book a follow up test at their GP practice which will be a standard screening test (HPV primary screening test). Compliance to this has been high (~82%) in previous studies. Women will be managed according to their HPV primary test result under the NHS CSP.
- Women whose self-sample test result is unreliable/unavailable (due to insufficient DNA) or return an invalid sample (rejected by CSL), will be sent a repeat kit and explanatory letter in the post. Women will be invited to book a standard screening test at their GP Practice if they prefer.
- Further information can be found in the HPV Flowchart.
NHS Digital have introduced YouScreen result/infection/action code combinations in NHAIS to support self-sampling. HPV results for self-samples will be received electronically via the usual way from CSL via Keystone. Practices will need to enter HPV self-sample results in the usual way using the self-sample codes developed for YouScreen.
Women will receive their results via post.
Yes, this also means self-samples collected for the YouScreen study will count towards QOF and CQC indicators.
If women prefer, they can make an appointment with their GP practice to have a routine cervical screening test instead of returning a self-sample.
If women choose to return a self-sample, they will be consenting to a self-sample as their cervical screening test. This means that if their self-sample tests negative for HPV, they will be consenting for their next test due date to be reset i.e. their next cervical screening will be in 3 or 5 years (depending on their age).
If women wish to have a routine cervical screen they should do so. This study is for women who (for whatever reason) are not up to date with their routine cervical screening. Women who are not adequately screened are at higher risk of developing cervical cancer. We hope that offering self-sampling will result in a higher proportion of screened women in the population.