Image: Archi Banal
Image: Archi Banal

SocietyFebruary 9, 2023

Explainer: How self-test cervical screening will work 

Senior writer
Image: Archi Banal
Image: Archi Banal

Big changes are coming to the old-school smear test in 2023. Allow us to explain. 

What’s all this then? 

From July this year, the traditional smear test will change to a new cervical screening test, officially called HPV Primary Screening, which has been proven to identify those at a higher risk for human papilloma virus (responsible for 99% of all cervical cancers) much earlier than the current test. It also means the end of the dreaded speculum and the option to self-test in private if patients would prefer. In future, at-home testing could even be on the cards.

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Why is this such a big deal? 

In Aotearoa, about 160 women develop cervical cancer and about 50 die from it every year. The leading cause of cervical cancer is HPV. Regular smear tests every three years can catch early changes to the cervix and reduce the chance of developing cancer, but the rates of testing and diagnosis remain extremely unequal. For example, Māori women are twice as likely to develop cervical cancer than non-Māori, and have much lower testing rates nationally.

“We’re letting women, and their families down and that’s particularly true for Māori and Pacific women,” Dr Samantha Murton, President of The Royal New Zealand College of General Practitioners, told New Zealander Doctor in 2021. “Cervical screening has progressed and the best first test is now an HPV swab. However, our clinicians are asked to carry on with performing a test that could be done in a better way.”

Along with the outdated testing methods, gender diverse people are missing out on their vital smear screening notifications due to software glitches, testing numbers for younger people between 25-30 are continuing to plummet despite “funky” targeted campaigns, and there’s a massive backlog of over 50,000 smear tests thanks to the good old pandemic. Perhaps it’s no wonder that our cervical screening programme is in need of a bit of a shake-up in 2023?

How long has this newfangled test been in the works? 

Ages! In 2015, Te Whatu Ora consulted with members of the public, community organisations and health professionals about implementing a new form of HPV primary screening. The summary of findings stated that access to screening needed to be made more equitable and that the overall safety and quality needed to be improved. It also said the new HPV test was “a natural step forward to improve the quality, safety and effectiveness of the programme”. 

Although it was originally to be introduced in 2018, the programme faced multiple delays and postponements. In 2020, The National Māori pandemic group, Te Roopu Whakakaupapa Urutā, wrote a letter to then-director general of health Dr Ashley Bloomfield urging that the programme be re-prioritised. In 2021, the public conversation was ignited once more following Labour MP Kiri Allan’s announcement that she had been diagnosed with cervical cancer:

“I’ve told a few folks by now, and often the question is, ‘is there anything I can do?’,” Allan wrote on social media. “My answer is now yes. Please, please, please – encourage your sisters, your mothers, your daughters, your friends – please #SmearYourMea – it may save your life.”

Two months later, associate health minister Dr Ayesha Verrall announced that the government would be investing $53 million into implementing a simpler way to test for HPV. “Current practice is inefficient and unnecessary,” she said in a press release in June. “The delay in accessing this vital information, can mean screening decisions are not made on the spot, and an extra appointment may be needed. This may deter women from seeking the help they need.”

Kiritapu Allan (Photo: Hagen Hopkins/Getty Images)

Why would people not want to get tested? 

As the 2015 consultation found, there are many reasons why people might not get their regular three-yearly smear. These included having limited health literacy, living with a disability, living rurally, having a history of sexual abuse or having general fear or anxiety about the procedure. As Allan herself reflected in 2021: “I’m one of those gals that hates anything to do with ‘down there’. And have taken a ‘see no evil, hear no evil’ type approach to that part of my body.”

For those who have experienced sexual trauma, the barriers can be insurmountable. In the wake of Kiri Allan’s diagnosis, poet Trinity Thomson-Browne (Ngāti Kahungunu ki Wairarapa, ki Tāmaki nui-a-Rua, ki Wairoa) voiced their frustrations around the “outdated and out-of-touch” practice on social media. “I looked at my two options, and they were: relive your trauma, or run the risk of dying,” they told The Spinoff in 2021. “Those are two really awful options.” 

After sharing their concerns, Thomson-Browne received a flood of messages of support and recognition from sexual harm survivors, people who have experienced birth trauma, disabled people and people living with chronic illness, and those who had generally encountered racism, misogyny and fatphobia in healthcare. “I wouldn’t have spoken out if I didn’t have so many people reaching out and saying ‘This is me too’,” they said.

There are many reasons why people avoid their smear. (Photo: Getty Images)

How will the self-administered test actually work? 

According to the National Screening Unit website, “it is likely participants will still access their health care provider for the cervical screening, even when undertaking self-testing”, meaning you will still have to visit your local clinic (for now) to get tested. The good news is that early trials of the initiative in Northland have been described as “empowering” and “mana-enhancing” by those involved, who can opt to do the vaginal swab themselves or have their doctor do it. 

If you are after more gory details, Stuff’s Josephine Franks bravely recounted her experience of trying out the “lanky cotton bud” in her office first aid room in this funny and informative story. “The actual swab is the same as what’s used for the Covid test,” she explained. “Except instead of having a cotton bud twirled around an unfathomably deep part of your nose, the HPV self-swab doesn’t need to go more than a centimetre or two into your vagina.” 

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Overall, Franks described the test as “easy” to self-administer. “If you’ve origami-ed a mooncup, inserted a tampon – or basically anything else – into your vagina, the spaghetti-thin swab is barely a tickle,” she reflected. And in even better news, Te Whatu Ora has said that it “will be looking at ways to make screening even more accessible in the future” which could involve mail-outs of self-testing kits across the country. 

Although the new test won’t be rolling out nationwide until July, the advice remains the same: do not wait to get tested. “The current screening test (commonly known as a smear test) is clinically safe and continues to be a very effective tool for reducing cervical cancer,” the screening website reads. “If you haven’t had a screen in the last three years, get in touch with your doctor, practice nurse or health clinic, or call the National Screening Unit on 0800 729 729.”

Click here for more information on cervical screening in Aotearoa

Keep going!
Image: Archi Banal.
Image: Archi Banal.

SocietyFebruary 8, 2023

Auckland’s ferocious floods took the city back in time

Staff Writer
Image: Archi Banal.
Image: Archi Banal.

Paved-over rivers, covered-up shorelines and filled-in wetlands reemerged during Auckland’s devastating deluge – taking the city 200 years back into the past.

Tāmaki Makaurau’s recent flooding has stirred up plenty of kōrero about our biggest city. Architecture and urban planning professor Timothy Welch reminded us that we built Auckland in a way that exacerbates major weather events. Many commentators explored the role of the mayor during a crisis. A kaupapa less discussed is how the floods have been a physical reminder of Auckland’s past. During the flooding, Tāmaki’s pre-colonial landscape partly reclaimed itself in the form of historic waterways. 

Across the region, former rivers, beaches and wetlands that were paved over, covered up and filled in by urban development reemerged. Streets became rivers, parks became swamps, and reclaimed land returned to being underwater. In a way, the recent flooding has forced Aucklanders to step back in time. Although Auckland didn’t board the rainy time machine willingly, having history reveal itself in such a tangible way provides a great moment to reflect on what once was and what the future holds. 

Children boogie boarding at the flooded Auckland Domain.
The flooded Auckland Domain became a site for boogie boarding, as seen here, as well as paddle boarding, kite surfing, kayaking, aquatic biking and dog bathing (none of these activities are recommended in floodwaters) (Image: Supplied)

One Auckland landscape that dramatically returned to its historical form was Pukekawa, the Auckland Domain. The southwest corner of Pukekawa, adjacent to Carlton Gore and Park roads, typically consists of playing fields underneath the grandstand. But Auckland’s record rainfall made the playing fields resemble a lake several feet deep, and that’s exactly what that corner of Pukekawa was historically – a lake. The lake formed in a volcanic crater (yes, Auckland’s Domain and museum are built on a volcanic field) and eventually became a swampy wetland. Tangata Māori used the swamp to collect water and eels, but settlers drained it in the 1860s to provide space for the current playing fields. Another wetland turned playing field, Eden Park, flooded badly during the devastating deluge.

Normally, Queen Street is the centre of New Zealand’s commercial capital, but it looked more like a river while Auckland was pelted by record rainfall. That’s because the Queen Street valley used to be a natural water outlet into the Waitematā Harbour, with the Waihorotiu awa historically running down much of its course. From its source in what is now Myers Park, the Waihorotiu awa carved out the valley that Queen Street now inhabits, draining into the sea at the old foreshore on modern Fort Street. Kāinga were dotted around the banks of the awa, with their inhabitants sustained by its abundant fresh water supply and thriving fish stock.

However, as colonial Auckland grew, settlers desecrated the awa by turning it into an open sewer. In the 1860s, it was covered up, becoming an underground sewer. The Waihorotiu awa is only one of many covered-up rivers and streams in Auckland that dangerously roared back to life during the recent floods.

Another example was found nearby at Ponsonby’s badly flooded Western Park, where the now-covered Tunamau awa used to be. The CBD’s historic waterways ran into the sea at the old shoreline, which was filled in to reclaim extra land for Auckland city in the late 1800s and early 1900s. 

A historic photo of Auckland’s Queen Street, with the once thriving Waihorotiu Awa, turned settler open sewer precariously sitting below the street. (Image: Auckland Libraries Heritage Collection 4-400)

Much of the old foreshore flooded badly during Auckland’s devastating deluge. From Freemans Bay in the west, across to lower Queen Street in the centre and east to the bottom of Parnell, the historic shoreline was once again submerged underwater. 

Although this story has focused on central Auckland, the tale of nature reclaiming itself during flooding has been seen across New Zealand. Unfortunately, nature deciding to reclaim its historic waterways will only increase in the future. The ever-worsening climate crisis will make extreme weather events, like ferocious floods, more common. That makes adaptation crucial to avoid more lives being stolen. Landscape engineer Mark Lewis believes one potential adaptation could be returning covered-up urban waterways to their natural open-air state. “A stream by its nature has a higher and more variable capacity than a pipe,” commented Lewis. He also stated that “Nature-based solutions will be key to our success in responding to climate change.”

A collage of flooding in Freemans, compared to the old shoreline and the flooding sites when dry.
Freemans Bay, once an actual bay along the shoreline, now reclaimed land, seen in its dry and flooded forms next to an image of the old shoreline. (Images: Getty Images and Wikimedia)

Auckland’s devastating deluge has forced the city to look forward to the future in search of solutions. But the flooding has also been a reminder of the past, with historic wetlands, rivers and shorelines reclaiming their watery forms. 

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