6 Apr 2021

Health leader 'baffled' why HPV self-test not govt-funded

From Checkpoint, 5:45 pm on 6 April 2021

Women are dying while the government drags its feet on funding a new cervical cancer screening programme, according to a leading women's health researcher.

Minister Kiritapu Allan revealed today she has stage 3 cervical cancer and has medical leave to concentrate on what she is calling the fight of her life.

In a social media post she talked about taking a "see no evil, hear no evil approach" when it came to that part of her body and described the symptoms she had been suffering including stomach, back and leg pain and continuous bleeding.

It has prompted renewed calls for the government to fund a self-swabbing cervical cancer programme that allows women the privacy and convenience of taking a simple test at home.

It was due to be rolled out in 2018, but the government put it on ice.

Te Tātai Hauora o Hine director Dr Beverley Lawton, who conducted a pilot study of the proposed HPV self-screening, said she could not understand the delay, and she was saddened to hear of Allan's diagnosis.

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 Dr Beverley Lawton. Photo: © Victoria University of Wellington. All rights reserved.

"Myself and my team felt very sad… These are young whānau, it's very sad considering that it's now a preventable disease," she told Checkpoint.

The government was not serving women well on cervical cancer screening, she said.

"It's really failing a section of New Zealand, and its failure on two counts. One, it's not reaching everyone it should reach, because that's its responsibility as a programme. And secondly, it's using a poor test, a second-class test. What they're doing now is cytology - that is now a second-class test. There is now a gold standard test, which we should be using in New Zealand."

Dr Lawton said she was "totally baffled" why the self-swabbing test was not freely available yet.

"We were not talking a lot of money here. This was supposed to start in 2017.

"And it wasn't just the self-testing. It's moving to the gold standard test which is looking for the [HPV] virus.

"The primary test was supposed to be starting to be rolled out in 2017… Australia has HPV primary testing, the UK has, we're really behind. And this is women's lives at risk because of this.

"The self-testing is the new technology that's come into it, which is really exciting because that's just as good as if a doctor does it."

Dr Lawton said the cost of providing that test to New Zealand women would be about $40 million over three years.

"[The HPV test] will save money in the long run because this test is every five years. It's a viral test. And it's very effective at finding those abnormalities on the cervix.

"I hear people every day talk about $3 billion going to be spent on this and another $3 billion on this. We need a small amount of money to do a programme that the ministry already says is best practice.

"I don't understand, it baffles me, the whole thing means women are the bottom of the heap. Compared to all the money that's being spent at the moment this is nothing over three years."

Dr Lawton said the current screening programme was not working because it did not reach out to communities, and there might be stigma about sexual health for some people.

"Also it's cost, it's distance, it's you're working … there's a number of reasons why, and that is contributing to the programme not being able to help all women in New Zealand.

"There are a lot of places women can go for a free smear test, and it depends on the area.

"Some DHBs have special sessions, but a lot of rural areas – the smear is free. Free means you've still got to get the time off. There's a lot of reasons."

The self test swabs were the same as what was used for the Covid-19 swab.

"You go into the bathroom, it might be at home, usually at the clinic, and in your own privacy you undo it… it's a little cotton bud basically, it goes into the vagina, and you swirl around, not very far at all.

"Many, many women are doing these tests now for looking for infections. So women are familiar with doing their own tests, and I've done this many times with women who's never done a test.

"They think they can't do it but they do it beautifully. Women throughout the world know how to test their vagina.

"We asked women what they thought about it, they really liked it, they felt it empowered them, it was easy to do, and they felt more in control.

"The Ministry of Health, it's all over the website. We just need money… we just need a decision, and the decision is from government. And I'm totally baffled - this is not a lot of money, and there are millions of women, over a million women screening in New Zealand, and there would be more."

Dr Lawton said she had written to the prime minister, but had no reply.

"She needs to push the button. This is unacceptable. Women are dying unnecessarily. The programme is cost effective, so let's just get on with it."

In a statement, a Ministry of Health spokesperson said the ministry "remains committed to introducing HPV primary screening and self-testing as international evidence convincingly shows it is the most effective test".

"A significant challenge remains the limited adaptability of the current National Cervical Screening Programme (NCSP) Register and the need for a custom-built IT platform that incorporates the new clinical pathways, necessary safety-nets and programme monitoring capability.

"Government funding will be required to support both the programme change and the development of a new component on the National Screening Solution (the National Bowel Screening Programme is on this platform). The NCSP is continuing to progress this important work."