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.

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Along with the outdated testing methods, gender diverse people are missing out on their vital smear screening notifications due to software glitches, testing numbers for younger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.”

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.

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.” 

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