With one in four eligible Australians overdue for screening, experts say expanding self-collection beyond traditional primary care could improve access and equity.
In the Australian National Cervical Screening Program (NCSP), one in four screen-eligible people are overdue for cervical screening.
In the most disadvantaged areas of our country, this is even higher, with one in three being overdue. Recent national data indicates that the proportion of screen-eligible people who are up to date with screening is declining for the second year in a row, from 76.5% at the end of 2022 to 74.2% at the end of 2024.
The declines in people being up to date are seen around Australia. Innovative solutions are needed to improve participation in screening.
Cervical screening, including screening using a self-collected vaginal sample (self-collection), is mostly offered in-person in primary care. There are many advantages to this, including the opportunity to discuss questions and other health issues.
The engagement and support of primary care in cervical screening has been seen as one of the factors in the success of the NCSP, which halved cervical cancer rates in the first decade after it began in 1991.
There are however, increasing barriers to accessing primary care. The Consumer Health Forum 2025 National Consumer Sentiment Survey of a nationally representative sample of over 5000 Australian adults identified that around one in four did not see a GP when needed, and one in five did not have a recommended test, treatment or appointment.
Around one in three said cost was the driving factor, another one in three said the service was not available at a time that suited them, and one in four said they were too busy.
Very similar responses were seen in the Australian Bureau of Statistics Patient Experiences survey in 2024-2025: one in four people had delayed seeing a GP, in many cases due to cost but mostly due to other reasons such as the timing when the service was accessible and lack of time. Females and those aged 25-34 years were more likely to defer care.
The introduction of self-collection as a universal option for anyone eligible for cervical screening has provided individuals with more choice in how they were screened – and it has also enabled screening to occur in a wider number of settings than before.
While a healthcare provider must be responsible for ensuring that participants receive their results and arranging any follow-up needed, NCSP Guidelines provide considerable flexibility in how and where self-collection is offered, provided these systems are in place.
At a time when accessing primary care is a challenge for many people, the flexibility offered by self-collection provides opportunities to offer screening in other ways.
Supporting Choice for Cervical Screening, is a NHMRC-funded program of work that is working to understand how self-collection for cervical screening can be implemented in ways that genuinely improve access, equity and participation in screening. This includes understanding how it can be used to address barriers to accessing screening for population groups who experience additional personal, cultural, logistical and financial barriers.
Findings from interviews and surveys conducted with healthcare providers and community members as part of Supporting Choice consistently show that to achieve more equitable participation, we need to use the flexibility that self-collection offers to enable access to screening outside of primary care.
This doesn’t necessarily mean replacing the primary care model that works for many people; it means providing other options so that everyone can access screening on time, in a way that’s affordable and convenient for them, and that provides them with the right information and support.
Some examples of flexible screening models used around the world include mail-out, community outreach, telehealth, and ordering a kit online or picking one up at a pharmacy or clinic without needing an appointment.
Some of these have already been used in Australia.
We want to understand what healthcare providers think about flexible models of cervical screening
To ensure potential models are practical and safe, we want to better understand clinical perspectives: where these models may have advantages, what challenges they might present, and what key issues need to be addressed. We’re exploring this in our current national survey of healthcare providers.
This survey follows one conducted in early 2023 after the NCSP policy change in July 2022 that recommended anyone eligible for cervical screening be offered their choice of self-collection or a clinician-collected sample. We explored how healthcare providers were integrating self-collection into their clinical practice, and their experiences.
As well as understanding healthcare provider perspectives on flexible models of cervical screening, we also want to understand what has or hasn’t changed since our previous survey, and any remaining or new challenges.
In our previous survey we found that providers who were not yet offering self-collection to everyone were less likely to report they had been offered training covering self-collection, and some want more information resources for patients or themselves.
Since then, there have been major government-funded education and awareness campaigns for self-collection. National community-focussed campaigns Own It and Screen Me were preceded by a campaign focussed on healthcare providers, aiming to equip them to confidently offer choice, including webinars, presentations at major conferences, and online resources.
Our community survey showed strong interest in accessing cervical screening in ways that didn’t require an appointment. When asked to select from a range of future possibilities, more than 80% nominated an option that didn’t require a primary care appointment (either in-person or online).
Most commonly this was receiving a swab in the mail when they were due and doing the test at home or ordering a swab online/ over the phone or picking one up at a pharmacy.
Their reasons reflect issues with accessing primary care, such as a non-appointment-based model being more convenient, less expensive, or available outside work hours.
People were more likely to prefer an option without an appointment if they were overdue or unscreened (including newly eligible people around 25 years) and also if they were university-educated.
Interestingly, people who spoke a language other than English at home tended to prefer appointment-based models where they could speak to a healthcare provider.
Related
In interviews with a range of service providers for Supporting Choice, we heard that some services were already using the using the flexibility that self-collection offers, doing innovative and exciting things to reach their communities through outreach activities.
Others wanted to do more but were not sure how. To bridge this gap, we developed a Community Outreach Toolkit for cervical screening in collaboration with a range of organisations, including those already delivering screening through community outreach or pop-up clinics, and organisations in the cancer screening sector.
It provides practical guidance and tips to help healthcare providers and organisations plan, run and evaluate cervical screening outreach activities, based on research and the experience of those already doing it.
Several organisations provided case studies about their experience, including:
- ACON, which runs pop-up screening clinics at LGBTQ+ community events.
- Canberra Women’s Health Service, IPC Health and WHISE, which delivers health education and screening by a registered nurse to people with a refugee and asylum seeker background and multicultural communities at a range of community-based settings, including English language classes, mums and bubs groups, or places of faith.
- True Relationships and Reproductive Health, which provides screening by trained nurses through an existing reproductive and sexual health service for people living with a disability.
- SHINE SA, which provides cervical screening at weekly health clinics in prisons and also established a peer-supported clinic for transmasculine clients.
- Northern NSW Local Health District, which delivers cervical screening by a clinical nurse consultant through an outreach women’s health clinic in rural and remote towns, using existing settings like community centres, aged care homes, or home settings for clients with mobility issues.
What else?
Some of the other solutions that Supporting Choice research suggests could improve cervical screening participation, particularly among groups who are less likely to be screened regularly include:
- Tailored resources – many are now available through Australian, state and territory government programs and websites (for example information in different languages, in easy read format, or as videos). As well as government websites, you can find resources on the Own It and Screen Me campaign websites or check with Cancer Councils or other community organisations.
- Training and upskilling in working inclusively with different population groups. There are a range of online resources and toolkits available, for example Aboriginal and Torres Strait Islander Cultural Awareness in General Practice, LGBTQ+ awareness and inclusion training, fostering knowledge, skills and tools in the field of trauma, and supporting screening in people with disability.
- Information, upskilling and training for providers and other staff about self-collection. Ensure non-clinical staff are aware of different screening options.
- Flexibility in people not having to return to primary care for results – in light of barriers people report accessing primary care.
Modelling shows that cervical screening is the fastest way to reduce cervical cancer rates. Ensuring access to cervical screening is therefore critical to achieving equitable elimination of cervical cancer as a public health problem (<4 cases per 100,000 people) in Australia by 2035, in line with our national target. The flexibility that self-collection provides enables us to offer cervical screening in ways that are more convenient, private, autonomous and empowering to all, especially those who are under- and never-screened. We want to hear from you about how we can use this flexibility to ensure screening models are practical and safe, and how self-collection is working in your practice.
You can complete our survey here until April 30.
To find out more visit the Supporting Choice website see here.
Associate Professor Megan Smith is an epidemiologist and simulation modeller with extensive experience in policy evaluations for cervical cancer prevention, including screening and HPV vaccination.
Claire Bavor is a PhD candidate and research assistant in the Evaluation and Implementation Science Unit at the Melbourne School of Population and Global Health.
Links available on request
