Self-testing for cervical cancer screening is a game-changer for wāhine Māori, writes Fred Christensen, who’s seen the proof in Wairoa.
A landmark study published this month in The Lancet confirms that a simple, private self-test can increase cervical cancer screening by more than 60 percent. This is critical for a disease that kills Māori women at twice the rate of Pākehā women, yet is entirely preventable.
Eight out of every 10 cervical cancer cases in New Zealand occur in women who’ve never been tested. The disease originates with the Human papillomavirus (HPV), which causes some 600 cancer cases every year, including cervical as well as anal, vulva, vaginal, penile, and up to 50 percent of head and neck cancers.
Unlike most forms of cancer arising later in life, cervical cancer strikes women when they are in their child-raising and working years. It’s one of the leading causes of cancer deaths in women under 40, and the second leading cause of cancer death in Māori women aged 25–44.
Much of that tragedy lies in the fact that the Māori testing rate is half of the Pākehā rate.
HPV, cancer and cervical smears
HPV is a ubiquitous virus infecting 80 percent of humans, usually with few consequences. While most strains don‘t cause any symptoms, a few strains cause benign warts on the hands, feet or genital area, which show up as small lumps. These usually clear naturally, are not dangerous, and can be treated or simply left alone.
However, there is a much more dangerous set of strains. Primary among those are HPV 16 and 18, which cause about 70 percent of cervical cancer cases. The risk rises when high-risk strains infect cells in the cervix, and, instead of clearing, persist for years. This can eventually lead to abnormal cell growth and, ultimately, to cancer.
Until fairly recently, cervical cancer screening for women aged from 25 to 69 relied on cervical smears, a discomforting procedure carried out by a nurse, to detect abnormal cells.
Just the thought of a cervical smear was enough to discourage participation, and may be one reason so many Māori women ignored screening altogether. As a result, the incidence of cervical cancer is about twice as high among Māori women as their Pākehā counterparts.
But in September 2022, Aotearoa introduced HPV self-testing. This new testing method allows women to swab themselves at a health provider or GP practice.
It’s easier, faster, and more private than the traditional cervical smear. Under this new method, those smears are only needed for women who test positive for high-risk HPV strains.
The swab for self-testing. (Image: RNZ Angus Dreaver)
Wairoa leads by example
The small, isolated, rural town of Wairoa, on the east coast of the North Island, has become a case study for moving forward. The town is home to a 70 percent Māori population, and faces serious economic and healthcare challenges.
Wairoa’s Queen St Practice (now Te Wairoa Medical Centre), led by Marion Terry and Bobbi Kaimoana, was one of the first sites in the country to use the HPV self-test and rapid follow-up processes for diagnosing women.
A group of researchers from Te Tātai Hauora o Hine at Te Herenga Waka University of Wellington worked with the practice’s local nurses to test 700 women in Wairoa over two and a half years. About one in 10 tested positive for high-risk types of HPV. Of those, 95 percent were referred and attended a colposcopy, which is the recommended follow-up procedure after an abnormal test.
“This is a testament to the trusting relationship that women have with their primary care health practitioner in Wairoa, and to the information that nurses and doctors were giving women with positive results, supporting them to attend colposcopy,” says the group’s senior researcher, Jane MacDonald.
Another study from last year showed that 95 percent of all women in New Zealand chose HPV self-testing when their screening was due. In that research project, 3 percent were positive for HPV 16/18, and another 10 percent carried other genotype high-risk HPV strains.
Instead of simply mailing kits and hoping for the best, the process promotes access for everyone through the use of trusted GP practices, community involvement, and patient education.
As a result, New Zealand is now regarded as a leader in universal HPV self-testing, particularly in successfully engaging with an Indigenous population.
Professor Bev Lawton, founder and director of Te Tātai Hauora o Hine – the National Centre for Women’s Health Research Aotearoa. (Image: Charlie Dreaver)
A double-sided equation
While testing is critical, it’s only one side of the equation for eliminating cervical cancer. Testing must be combined with vaccinations to be truly effective. New Zealand administers the Gardasil vaccine through school campaigns starting in Year 8 with 12-year-olds.
The standard of care involves two doses given six months apart. While some may be hesitant to participate, the facts are clear. First, the vaccine is more than 90 percent effective in preventing HPV infections and cancers. Second, aside from temporary swelling and pain at the injection site, the risk of a severe allergic reaction is extremely rare — about two cases per million doses.
The real issue now is that our vaccination rate is only 57 percent, near the bottom of comparable countries and far behind Australia, where 84 percent of people are vaccinated.
So what can we do about the vaccination rate?
During Covid, New Zealand experienced a 20 percent drop in HPV vaccination rates due to lockdowns, prioritisation of the Covid vaccine, and misinformation. And while most receive their vaccines at school, this requires a parental consent form, which is often not returned. Still, anyone can get the vaccine at a GP practice until the age of 45.
“It’s really a matter of positive messaging, grassroots support and community endorsement,” says Jane MacDonald. She’d like to see different organisations, including researchers and the health and education ministries, join forces to combat the low rates.
Researchers now advocate a four-pronged approach to eliminate cervical cancer with aggressive national goals.
These include a 90 percent vaccination rate, an 80 percent screening rate across all ethnicities, a 95 percent diagnosis rate via colposcopy, and a 90 percent treatment rate for those with cancer.
We know that cervical cancer is almost totally preventable. It’s also easily detectable through non-invasive means and highly treatable if caught early. For proof, consider Australia, which is on the verge of eliminating cervical cancer as a public health problem.
New Zealand could do the same, but keeping women free of cervical cancer requires trust in your doctor, nurse and public health system.
Wairoa has shown what’s possible when there’s high trust between local health providers and their communities, says Jane MacDonald: “No one in Aotearoa should get cervical cancer or die from it. Every case is unjust and unnecessary.“
Fred Christensen hails from Bend, Oregon in the United States, where he led IBM strategic partnerships for over 20 years. In 2024, he moved to Wairoa with his wife, so she could practice as a GP. He now works for the Wairoa District Council, is a substitute teacher and writes the weekly HealthTalk column for the Wairoa Star.
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