Introduction to HPV primary screening

The National Cervical Screening Programme (NCSP) uses HPV testing as the primary screening test.

What is HPV primary screening and why is it needed?

The World Health Organization (WHO) has launched a global strategy to “eliminate cervical cancer as a public health problem, [by achieving] an incidence rate of less than 4 in 100,000 women”. NCSP has made great progress through the implementation of the screening process to bring this down, but more needs to be done to achieve the WHO goals.

However, there remain significant ethnic disparities, with disproportionately high cancer rates in Māori and Pacific people. 85% of people who develop cervical cancer in Aotearoa New Zealand either have never been screened or have been screened infrequently.

From late 2023, the NCSP will implement HPV primary screening with the option of self-testing under clinical oversight and upgrade the supporting information and communications technology. ​

Watch a 5-minute video which provides a basic introduction to HPV testing, which will become the primary screening method for cervical cancer prevention in Aotearoa New Zealand. 

What are the changes?

The changes in primary screening for HPV involve a significant shift in methodology.

This new approach entails testing for the presence of HPV. This complements or replaces the traditional method, the taking of liquid based cytology (LBC) samples (previously known as a “smear test”). By adopting HPV primary screening, the goal is to enhance the accuracy and sensitivity of screening, enabling early detection and intervention for improved health outcomes. HPV testing is a better primary screening test and will prevent more cervical cancers.

For most people, self-testing will be an option. A vaginal swab can be taken by the participant in privacy at a health clinic, or it can be taken by a clinician if preferred. The participant may also be able to take the test off site, for example, in a non-clinical setting in the community, if the healthcare provider agrees to this. The clinic will be responsible for getting the sample to the laboratory.

When are changes coming?

The implementation will be carried out in a series of stages.

The first phase, from go-live, will focus on introducing new clinical pathways and providing more support for screening. The NCSP-Register will be implemented and adopted by existing users, leading to a better identification of the eligible population for improved screening participation. Laboratories and Colposcopy clinics will be prepared to handle the new tests and accommodate varying volumes. A nationwide media campaign will be launched to promote the new test. While most participants will have the option to choose between self-administered or clinician-administered HPV screening tests, there will be a particular emphasis on Māori and Pacific participants, as well as increasing screening rates among those who have been under- or unscreened.

The second phase, anticipated to take place later in 2023, aims to build on the initial progress by expanding the participant base and further increasing screening uptake. This will be achieved through a notification strategy that focuses on Māori and Pacific populations, as well as prioritising those who have been under- or unscreened.

The final phase, expected to occur in early 2024, aims to achieve the desired future state and establish a process of continuous improvement.

For more information on the phasing, please read the full Road to Roll Out Pack here.

For more information on what’s changing for you, please go to the role-specific pages here.
 

What are the new options for testing?

In the National Cervical Screening Programme, most people can choose how their test is done. The options are:

1.        A self-test swab sample taken from the vagina (not the cervix) which is tested for HPV

2.        A clinician-taken vaginal swab sample which is tested for HPV, or 

3.        A clinician-taken cell sample from the cervix, previously referred to as a smear test, which is tested for HPV. This option also allows for a cytology test to be done if HPV is detected without needing to return for a further test.

Self-testing is not appropriate for everyone (for example, people who have symptoms or require a co-test for follow up after treatment). A self-taken vaginal swab is just as good as a clinician-taken sample for detecting HPV. 

How often does screening occur under the new test?

The 5-yearly HPV screening test replaces the 3-yearly cytology test, which looks for cell changes (previously known as a smear). The HPV test is a better first screening test than the previous cytology test. It is very sensitive in finding the virus that causes the cell changes. Cervical cancer often takes 10 or more years to develop. If you don’t have HPV your risk of developing cell changes that may cause cancer within 5 years is very low. People who are immune deficient are at a higher risk of developing cervical cell changes so are recommended to have 3-yearly screening. 

What about funding?

The NCSP is not a fully-funded screening programme. Most participants will pay a fee for the service provided. Some funding is available for free screening, especially for Māori or Pacific people. Screening Support Services (SSS) are available in many locations for women/wāhine and people with a cervix who are Māori and Pacific aged 25–69; and all women and people with a cervix,  aged 30–69 who are under- or unscreened. Details are available here: https://www.nsu.govt.nz/health-professionals/national-cervical-screening...

Keep up to date

New additions to this page will be highlighted in Sector Update newsletters. You can subscribe to these by emailing us at [email protected]