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January 2022

Non-speculum cervical screening increases uptake



Offering clinician-taken sampling without a speculum and self-sampling substantially increases cervical screening uptake in older lapsed attendee women across all ethnicities.

Under-screened and unscreened women are at the highest risk of developing cervical cancer yet screening uptake has been falling. Offering women a choice of screening tests that can be taken without a speculum increases uptake and helps ensure more women are protected from cervical cancer, according to a study in the British Journal of General Practice.

The authors say the speculum is a key barrier to cervical screening attendance. Many women who don’t come for cervical screening have a fear or a dislike of the speculum, and speculum use can become particularly painful for women around the menopause.

And while self-sampling has been hailed as a game changer for cervical screening, many women worry that they will not be able to do it correctly. An alternative is for a nurse to take a sample without using a speculum.

In a study at 10 GP practices in East London, 784 women aged 50-64 who were overdue screening were randomised to either receive a letter offering the choice of having a clinician-taken sample without a speculum or a self-sampling kit, or to usual care.

They found that 17% more women were screened when offered the option of having a test without a speculum compared with women who were offered standard screening (31% in the intervention group vs 14% receiving usual care). More women chose the self-sampling option than non-speculum screening.

Responses to a survey of participants found both non-speculum and self-sampling scored similarly in measures of acceptability, but a higher proportion of self-samplers were ‘not at all’ or ‘not very’ confident in the test accuracy. More women in the non-speculum group experienced embarrassment than in the self-sampling group, but also believed that it was important for a clinician to take the sample. A high proportion in both groups agreed or strongly agreed that it was important to have a choice.

The increase in screening uptake in non-speculum and self-sampling women persisted at 12 months, and was observed across all ethnic backgrounds, age groups, and screening histories.


Landy R, et al. Br J Gen Pract 2022;72(714):e26-e33

Practice Nurse 2022;52(1):7