We all know they’re important, but for many women smear tests feel invasive and uncomfortable, which may be why cervical screening attendance is at its lowest rate for two decades.
But a new test could put an end to the traditional “sweeping” of the cervix, allowing women to be tested for precursors of cervical cancer through a urine sample.
And the best part? A trial involving more than 15,000 women led by Queen Mary University of London found the test was more accurate than the current method, detecting 100% of cancers present in the cohort group.
Despite the positive result, it could be a while before the new method is available on the NHS. But lead researcher Professor Attila Lorincz told HuffPost UK the technology is there – so in theory this could happen within the next five years.
At present, cervical screening (previously called the smear test or Pap smear) involves a doctor or nurse inserting a speculum into the vagina and collecting cells from the cervix, which are then sent off for testing.
In recent years, scientists have also developed the HPV test. This is essentially another stage to the smear test where any sample taken during the smear showing low-grade or borderline cell abnormalities is then tested for HPV.
HPV is a common infection that’s harmless in most instances but many cases of cervical cancer are caused by it. There’s no treatment for HPV, but if doctors are aware of the virus they can monitor it – this means they’ll be able to provide treatment as soon as possible if it develops into cervical cancer (you can read more about HPV here).
The HPV test only identifies whether or not women are infected with a cancer-causing HPV, but not their actual risks of cancer. “This causes unnecessary worry for the majority of HPV-infected women who receive a positive result but will eventually clear the virus and not develop the disease,” the study authors said.
The NHS cervical screening programme uses a combination of the traditional smear method and HPV testing. However, the new “epigenetics-based” test was found to be more accurate than both current tests combined.
The epigenetic test involves looking for changes in the gene expressions in sample DNA. While the sample DNA can be taken from the usual vaginal examination or via an at-home smear test, it also works using a urine sample.
Rather than simply flagging HPV, it predicts the likelihood of HPV causing cell abnormalities to develop (if it’s contracted). It’s also less subjective than a human using a microscope, according to Professor Lorincz.
The new test detected 100% of the eight invasive cervical cancers that developed in the 15,744 women during the trial. In comparison, the smear only detected 25% of the cancers, and the HPV test detected 50%.
“This really is a huge advance in how to deal with HPV-infected women and men, numbering in the billions worldwide, and it is going to revolutionise screening,” Professor Lorincz said. “The new test is much better than anything offered in the UK at present but could take at least five years to be established.”
Speaking to HuffPost UK, Professor Lorincz confirmed that, in theory, a urine test could replace the current cervical screening programme. “The test is now ready to be taken forward into development for routine use,” he said.
However, he added that the test will need to go through multiple committees, so time scales are unpredictable: “In my experience the length of time it takes is highly variable.”