Self-collection greatly increased screening without reduced detection
Offering self-collected human papillomavirus testing through primary care increased screening participation, especially among under-screened women, while detection of serious disease after referral was similar to clinician collection.
*Retrospective cohort study; Level 2b (OCEBM).

Citation

Sultana F, Smith M, Saville M, et al. Uptake and performance of self-collection offered through primary care to all eligible participants in a national cervical screening programme in Australia: a retrospective cohort study. Lancet Public Health. 2026;11:e101–e110.

Background

Self-collected samples for human papillomavirus (HPV) testing can reduce barriers to cervical screening, but program-level evidence is limited. Australia expanded eligibility for self-collection to all screening-eligible women in mid-2022.

Patients

Women aged 25–74 years in Australia’s national screening register. Excluded tests done for symptoms or post-treatment monitoring; some outcome analyses excluded women lacking key follow-up records.

Intervention

HPV testing on self-collected vaginal samples facilitated through primary care.

Control

HPV testing on clinician-collected cervical samples.

Outcome

(1) Uptake of self-collection among all valid screening HPV tests. (2) Among those referred for specialist examination, tissue-confirmed high-grade pre-cancer or cancer.

Follow-up Period

Uptake: Dec 1, 2017–Dec 31, 2023. Performance after referral: tests Jul 1, 2022–Jun 30, 2023, with outcomes tracked to Dec 31, 2023.

Results

Finding Result
Self-collection uptake after eligibility expansion Increased from 1.2% (Q2 2022) to 26.9% (Q4 2023) of screening HPV tests
Highest self-collection uptake subgroups (Q4 2023) >10 years overdue: 51.9%; very remote areas: 53.9%; age 70–74: 33.5%
HPV positive tests (Jul 2022–Jun 2023) Self-collected 16.4% vs clinician-collected 14.8%
Detection of high-grade pre-cancer or cancer after referral No clear difference between self- and clinician-collected samples after adjustment for patient differences
Follow-up data were less complete after self-collection than clinician collection.

Limitations

Retrospective design and short outcome window. More missing follow-up data after self-collection, partly due to care not matching guidelines, could bias comparisons. Uptake measured “share of tests,” not true population participation.

Funding

No external funding; Australian Government custodians approved publication.

Clinical Application

Offer self-collection as a standard option in primary care to reach under-screened women; ensure reliable referral and follow-up processes so abnormal results are not lost.