Goodbye to the Smear Test?

Could we be saying “goodbye” to the cervical smear test? The uncomfortable necessity that women have to go through every three years could become a thing of the past with self-testing urine kits, according to researchers in England and Spain.

Cervical screening is available to women in Wales between the ages of 20 and 64. In Scotland, it's between the ages of 20 and 60, though next year this will be extended to 64. In England and Northern Ireland, women are offered smear tests between the ages of 25 and 64, and in the US, the test is available to women between 30 and 64.

Although cervical screening is believed to save the lives of around 4,500 women in the UK every year, many women opt to forgo the uncomfortable procedure. Perhaps this is unsurprising when you consider that it involves a speculum being inserted into the vagina so that cells from the surface of the cervix can be collected in order to screen for HPV, human papillomavirus. NHS figures showed that between 2012 and 2013, although 4.2 million women were invited for testing, almost a million declined to attend.

HPV is thought to be one of the leading causes of cervical cancer and is so common and contagious that around 80% of sexually active women will be affected at some point in their life. Two of the highest risk strains, HPV 16 and HPV 18, are thought to cause 70% of all cervical cancer cases.

Because of this, experts from the Women’s Health Research Unit at Queen Mary University of London and the Clinical Biostatistics Unit in Madrid decided to analyse the data from 14 studies, involving a total of almost 1,450 women, to investigate the effectiveness of detecting the virus through urine tests. They published their findings online in the British Medical Journal .

It was found that urine tests were able to correctly identify HPV 87% of the time, with 94% of negative results also being accurate. Furthermore, for the high-risk strains of the virus, urine tests were 73% accurate when detecting and 98% correct with negative results.

“The detection of HPV in urine is non-invasive, easily accessible, and acceptable for women, and a test with these qualities could considerably increase uptake,” the authors wrote. They concluded that urine tests are accurate enough at detecting the virus that they could be “a feasible alternative to HPV testing of cervical samples collected by health professionals".

The hope is that enabling women to test themselves in the comfort of their own home, and sending their samples off to be analysed, will encourage women who have been ordinarily reluctant to undergo cervical screening in the past.

The next step is to research urine testing further to “identify the true clinical performance” of the method both as this means of encouragement and also in countries with low incomes that currently cannot afford to offer widespread screening.

So, fingers crossed that women around the world will be able to get the HPV screening they need - without the dread of stirrups and speculums - in the not-too-distant future.