Self-collection for cervical screening

Important update on self-collection eligibility expansion

As of 1 July 2022, anyone eligible for a Cervical Screening Test under the National Cervical Screening Program (NCSP), i.e. women and people with a cervix aged 25 to 74 years who have ever had any sexual contact, will have the choice to screen either through:

• self-collection of a vaginal sample using a simple swab (unless a co-test is indicated) or
• clinician-collection of a sample from the cervix using a speculum.

These changes mean that healthcare providers may start to see an increase in the volume of requests from patients to use self-collection as an option for their Cervical Screening Test. For more information, view the latest National Cervical Screening Program update on the self-collection eligibility expansion (PDF).

What is self-collection?

Self-collection is a screening option introduced under the National Cervical Screening Program (NCSP). It allows participants to self-collect a vaginal sample for human papillomavirus (HPV) testing.

As a self-collected sample is from the vagina (not the cervix), it can only be tested for HPV and not cervical cell abnormalities.

If HPV is detected on a self-collected sample, depending on the type of HPV, it is recommended a patient should have a speculum examination with a cervical sample collected for liquid-based cytology (LBC), or be referred directly for colposcopy.

Who is eligible for self-collection?

As of 1 July 2022, all NCSP participants aged 25 to 74 years are eligible for self-collection. Participants can choose to screen using either a self-collected vaginal sample or a clinician-collected sample from the cervix.

Who is not eligible for self-collection?

Self-collection is not appropriate for participants who require a co-test, for example because they:

• are symptomatic e.g. experiencing unusual vaginal bleeding, pain or discharge
• are undergoing Test of Cure surveillance
• have had a total hysterectomy with a history of high-grade squamous intraepithelial lesions (HSIL)
• have been exposed to diethyl-stilbestrol (DES) in utero.

Importance of self-collection

Self-collection provides a level of control and choice for patients, removing a significant barrier to participation in screening.

There are some groups that are less likely to screen, including:

• Aboriginal and/or Torres Strait Islander women
• people from culturally and linguistically diverse backgrounds
• people who identify as LGBTIQ+
• people with disabilities
• people who have experienced sexual violence
• post-menopausal women
• people who have had previous negative cervical screening experiences.

Self-collection may be more acceptable to these groups.

Accuracy of a self-collected sample for the detection of HPV

Recent evidence has shown that the sensitivity and specificity of HPV testing to detect CIN2+ in self-collected samples were similar to those for clinician-collected samples when using validated PCR-based HPV assays.

A self-collected sample is taken from the vagina (not the cervix). It can be tested for the presence of the human papillomavirus (HPV) but not cytology (cervical cell abnormalities). If HPV is detected on a self-collected sample, depending on the type of HPV, it is recommended a patient should have a speculum examination with a cervical sample collected for liquid-based cytology (LBC), or be referred directly for colposcopy.

Role of healthcare providers in self-collection

As of 1 July 2022, all NCSP participants aged 25 to 74 years have the choice to screen either by a self-collected vaginal sample or a clinician-collected sample from the cervix (accessed through a healthcare provider in both cases).

Healthcare providers:

• are well placed to talk with patients about their cervical screening options to help them make an informed choice.
• continue to play a central and critical role in the NCSP, in assessing patient risk and using clinical judgement to recommend testing and follow-up.
• will still need to offer a consultation for cervical screening whether it be a self-collected vaginal sample or clinician-collected cervical sample.

Where self-collection is chosen, healthcare providers will need to explain how to collect a self-collected sample, provide the swabs and offer information around test results and appropriate follow-up. During the consultation, patients should be provided with a private place within the clinic to collect their sample. For more information on discussing cervical screening with patients, refer to the Understanding the NCSP Management Pathway: A Guide for Healthcare Providers (PDF).

View the National Cervical Screening Program self-collection quick reference guide (external site) for information on how to facilitate self-collection.

During a consultation, healthcare providers may like to provide patients with the NCSP How to take your own sample for an HPV test (external site), a guide for patients on how to take a self-collected sample.

Additional resources to support the self-collection changes are available at Cervical screening resources | Australian Government Department of Health and Aged Care (external site).

Clinical guidelines for self-collection

The NCSP: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding (NCSP Clinical Guidelines) (external site) have been updated to support the expansion of self-collection. The guidelines bring together the best available evidence to prevent, diagnose and manage cervical cancer.

View the ‘Self-collected vaginal samples’ chapter (external site) of the NCSP Clinical Guidelines.

Check eligibility using the National Cancer Screening Register

Healthcare providers can access cervical screening histories held in the National Cancer Screening Register (NCSR) to check whether their patient is eligible for self-collection. To access information held in the NCSR:

• log into the NCSR Healthcare Provider Portal (external site) using a PRODA account
• access through integrated clinical software (external site)
• call the NCSR Contact Centre on 1800 627 701

Sampling instrument

There is a range of collection devices and methods available for use under the NCSP for self-collected vaginal samples. Self-collection devices and methods will vary by pathology laboratory and laboratories may have varying collection and handling instructions and requirements. Healthcare providers are encouraged to talk to their pathology provider.

Self-collection devices currently available include:

• Copan 552C dry flocked swab, red topped (for processing by accredited laboratories only)
• Copan 552C.80 dry flocked swab, red-topped (Roche validated)
• Copan 5E089C dry flocked swab, white topped (Becton Dickinson (BD) validated)

Processing self-collected tests

Providers of medical pathology services must clearly identify self-collected vaginal samples for HPV testing as part of the National Cervical Screening Program. This includes referring self-collected vaginal samples onto a laboratory who can process them, where necessary.

There is a range of collection devices and methods available for use under the NCSP for self-collected vaginal samples. As a result, different pathology laboratories may have varying collection and handling instructions and requirements.

Healthcare providers are encouraged to talk to their usual pathology provider in the first instance to:

• confirm that they can process self-collected vaginal samples, or
• confirm that they are able to refer self-collected vaginal samples to a laboratory that can process self-collected vaginal samples, and
• order the correct collection device and other consumables for offering self-collection, and
• confirm any collection, handling and transport requirements.

For more information about the self-collection devices and methods currently available, visit the National Cervical Screening Program website (external site).