There is a growing campaign to remove the costs associated with cervical screening in Aotearoa. Alex Casey explains.

What’s all this then? 

In July, Aotearoa is getting a big shiny new cervical screening programme after years and years and years of delays. The dreaded three-yearly smear test will be exchanged for an HPV self-test – basically a RAT-style swab test for your downstairs – that is more accurate, more accessible and only needs to be done every five years. With HPV as the leading cause of cervical cancer, this is a monumental move towards the elimination of a disease which disproportionately affects Māori and Pasifika, and leads to the death of around 50 women in Aotearoa every year. 

OK, so what’s the issue? 

It’s still going to come at a cost for most people, which has led to a growing number of health professionals and researchers petitioning to make the new programme entirely free of charge. “To ensure costs for screening and follow-up tests are not barriers, we are calling for a fully funded, equitable screening programme,” the petition reads. “This includes free screening and follow-up diagnosis and treatment. Unless urgent action is taken by the government to change what is proposed, there will be preventable deaths.”

“We’re in a time where people are struggling to feed their kids, so cost is one of the major barriers,” explains Bev Lawton, director of Te Tātai Hauora o Hine (the National Centre for Women’s Health Research Aotearoa) and principal investigator of He Tapu Te Whare Tangata (a project exploring cervical screening pathways for Māori). “Every time we ask wāhine in our studies all over the East Coast and Northland, cost is always a major issue.” 

How much does cervical screening cost? 

It varies hugely – not just from region to region, but clinic to clinic. Sandra Corbett, kaiwhakahaere (Māori co-ordinator) for cervical screening in Hawke’s Bay, explains that cervical screening can be provided free for priority patients, such as Māori and Pasifika patients who haven’t had a smear in the last five years. “If we recognise that a person has got challenges in their life, we will also try to accommodate them too,” she says. “But I’ll be honest, it is hugely variable.” 

These discretionary case-by-case decisions are why removing cost barriers for everyone is essential, says Corbett. “Within primary health care, sometimes you get people who act as gatekeepers, or make judgments about whether people should be offered a free one or not, which isn’t very helpful.” For everyone else, the price can fluctuate wildly. In her research, Lawton found the fee can be anywhere from $40 to $70. “All you have to do is ask around – it’s not hard to find people paying quite a lot.”

What about any follow-up tests? Do they cost too? 

Given that around 10 in every 100 patients will test positive for HPV, the cost of follow-up testing and treatment is another financial hurdle to clear. Dr Tania Slater is a senior research fellow at Te Tātai Hauora o Hine, and has seen how a positive test can add even more financial pressure. “If the result comes back and HPV high risk has been detected, you might need cytology, like an old school smear test, and you have to blimmin’ pay for that too!”

“Paying for health care is hard enough, but then paying to come back after the result is positive? That’s just a step too far for many,” she says. “It’s so, so hard for people right now – we’ve got inflation, we’ve got people not working, and then there’s all the flood stuff as well.” 

Lawton is clear about the impact these barriers are having. “We know there are lots of wāhine who just haven’t gone back for those important tests,” she says. “It’s a disgrace that women could be dying of an entirely preventable disease because of cost.” She is quick to add that the responsibility falls squarely on the system. “It has nothing to do with the people, it’s about the fact that the programme is failing and not reaching the people it should be reaching.” 

How does this compare to other screening programmes? 

The two other major national screening programmes – breast screening and bowel screening – are both entirely free for those who are most affected by the diseases. BreastScreen Aotearoa first launched in 1998, providing free mammograms and follow-ups every two years for women aged between 45 and 69 years. Bowel screening, launched in 2017, is free for everyone aged 60-74 (starting at age 50 for Māori and Pasifika) and involves an at-home test every two years. Both launched nationally as free screening programmes. 

Who’s in charge here and what do they reckon? 

Stephanie Chapman, Te Whatu Ora group manager for the National Screening Unit, explains that the National Cervical Screening Programme was first established in 1990, and was not based on a universally free screening model. Although successive parliamentary review committee reports into the National Cervical Screening Programme have recommended further funding to cervical screening, she says there are no plans for a universally free programme.

Chapman acknowledges that cost can be a barrier for people in attending cervical screening, explaining that the extra funding is currently provided by the NSU to primary health organisations, and then onto GPs, who are each able to decide how best to use the funds to assist their community. She recommends seeking out no- or low-cost options available through Te Whatu Ora providers, and reduced fees through organisations like Family Planning. 

What is the status of the petition? 

As of writing, the petition has nearly 3,000 signatures and has the public support of a range of organisations and voices including Mana Wāhine, Te Tātai Hauora o Hine, Hei Āhuru Mōwai Māori Cancer Leadership Aotearoa, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the New Zealand College of Primary Health Care Nurses, Tū Ora Compass Health, Dr Hinemoa Elder and Wellington mayor Tory Whanau. 

“Our end goal is that the government decides to give us this as an election year present,” says Lawton. “There’s just no point in starting a new programme that is not fully funded.” Her hope is that everyone will get on board, not just those who will be affected by it. “This isn’t just about wāhine – this is about tāne, this about whānau, this is about all of us. It is a very exciting opportunity for everyone to get on that bandwagon and help to eliminate cervical cancer.”