Eliminating cervical cancer
Preventing cervical cancer in Aotearoa New Zealand.
According to the World Health Organization (WHO), cervical cancer is one of the greatest threats to women's health. Globally each year, more than half a million women are diagnosed. In New Zealand, about 160 women develop cervical cancer each year and around 50 die from it.
Māori women face inequitable rates of cervical cancer. They are more than twice as likely as non-Māori women to be diagnosed with cervical cancer, and 2.5 times more likely to die from the disease. Regular cervical screening can reduce a woman’s risk of developing cancer by 90 percent.
34 percent of Māori women, compared with 21 percent of New Zealand European women, do not attend regular screening. To help eliminate health disparity, barriers to screening must be overcome, and screening must become acceptable and feasible for Māori.
In May 2018, WHO Director-General Dr Tedros Adhanom Ghebreyesus made a global call for action towards the elimination of cervical cancer.
Aligned closely with this global effort, the National Centre for Women’s Health Research Aotearoa (NCWHRA) is currently undertaking He Tapu Te Whare Tangata, a Kaupapa Māori research initiative currently funded by the Health Research Council of New Zealand. The study’s goal is to help eliminate preventable cervical cancer amongst Māori women through improved screening.
Human papillomaviruses (HPV) are a group of common viruses spread through skin to skin contact. If left undetected HPV can lead to cancer, including cervical cancer.
HPV self-testing is a new, highly effective, and potentially life-saving technology that enables women to self-test for HPV.
He Tapu Te Whare Tangata includes an acceptability study, a randomised controlled community trial, and a qualitative exploration of women’s experiences of the HPV self-test pathway. The trial aims to increase cervical screening amongst Māori women through the offer of HPV self-testing via clinics and community outreach.
Anna Adcock discusses the Centre's research into self-testing for HPV
He Tapu Te Whare Tangata’s acceptability study is now complete. This stage of the study looked at whether Māori women who have not been screened regularly would accept HPV self-testing. The study, conducted through face-to-face hui (meetings) and a survey, involved more than 500 Māori women as well as healthcare providers.
The study found the most frequently cited barrier to current screening was whakamā—embarrassment, shyness, or reticence. A lack of time and fear of discomfort or pain were also leading barriers.
Three out of four study participants would be likely or very likely to do a self-test for HPV, with nine out of ten reporting being likely or very likely to attend a follow-up if required. Hui participant responses to the idea were generally positive, with women using terms such as “easier”, “more comfortable”, “less intrusive”, and “brilliant”.
The findings suggest that, implemented in a flexible and culturally sensitive way, HPV self-testing may be very acceptable for Māori women, and that women respond well to the autonomy gained by doing their own test.
Randomised controlled trial
Findings from the acceptability study informed the Centre’s randomised controlled trial to determine whether the offer of the HPV self-test increases cervical screening for never-screened and under-screened women. The randomised controlled trial is now complete.
The study found that the offer of an HPV self-test could increase the uptake of cervical screening by almost three times for under-screened Māori women.
The offer of an HPV self-test also reached 48 percent of Māori women who had not had a cervical screen in more than 10 years and 43 percent who had never been screened, compared with 10 percent and 13 percent respectively for those offered the standard screening method.
The findings of this study are informing the ongoing development of the Ministry of Health’s National Cervical Screening Programme, with self-testing being explored as an option for making screening more accessible. This research provides valuable information to help make New Zealand’s screening programme more responsive to Māori women’s needs.