Do your own HPV swab: Cervical cancer screening just got easier

“With clean hands, insert the swab stick and rotate it gently before removing it. Then, swirl it in a vial of fluid.” 

That, coming from a clinic staff, probably sounds familiar, especially in post-pandemic times. But, those are not the instructions for a Covid-19 test – instead, this is how women can now self-collect a vaginal sample for human papillomavirus (HPV) DNA screening.

Having this option means it’s more comfortable and faster to test for potential risk of cervical cancer, which is the 10th most frequent cancer among women here, according to the Singapore Cancer Registry Annual Report 2021.

Certain HPV infections in women with a normal immune system may develop into cervical cancer only after 15 to 20 years, says the World Health Organization (WHO).

Since it might take a longer time to develop, early detection has benefits as abnormalities can be identified and resolved, making cervical cancer preventable, says Dr Wang Junjie, head and senior consultant, Department of Gynaecological Oncology at KK Women’s and Children’s Hospital.

The greater accessibility, convenience and privacy made possible with the new self-collection method means staying on top of cervical health is made simpler for women today.

Making sense of this sneaky virus

As described by the Health Promotion Board, HPV is a common infection often transmitted via skin-to-skin contact during sexual activity, including oral sex. It can also spread through contaminated sex toys, and in very rare cases, during delivery from an infected mother to her baby. 

You cannot get HPV by touching common surfaces or sitting on toilet seats.

WHO’s International Agency for Research on Cancer further explains that most HPV infections (there are over 40 strains) are cleared within two years, but high-risk persistent ones could develop into cervical cancer. 

Dr Wang adds: “There are about 12 to 14 HPV high-risk strains, with HPV 16 and 18 being the most high risk.”

While some low-risk infections can cause genital warts, says Dr Wang, women with high-risk HPV may not show any symptoms, which is also the case for early-stage cervical cancer. 

In advanced stages of cervical cancer, they may experience abnormal vaginal bleeding, such as bleeding after intercourse, between menses or after menopause. Other symptoms can include watery, bloody vaginal discharge accompanied by foul odour, and pain during sex.

Since HPV infection is largely asymptomatic, preventive care makes it easier to protect yourself against the infection and address it quickly after testing positive.

Preventative care that can make a difference

Cervical cancer prevention begins with the HPV vaccination from the age of nine to 26, which helps to guard against new infections. Following that, women aged 25 to 29 who are sexually active or have had sex are advised to do Pap smears every three years to detect abnormalities and manage infections not protected by the vaccine.

Those 30 and above, and not pregnant, can then test for HPV every five years. 

Those below 30 years old are exempted from screening for HPV as the infection typically clears up on its own in younger patients, shares Dr Chng Shih Kiat, family physician and medical director of Raffles Medical Group. 

While these interventions are in place in Singapore, statistics tell a different story. The Ministry of Health reported that only 43.1 per cent of women went for cervical cancer screening in 2022, down from 57.9 per cent in 2007.

Dr Edwin Ch’ng Aik Chen, medical director of Parkway Shenton, says the top barriers keeping women from getting screened are a lack of knowledge about cervical cancer, misconceptions about the testing procedures and fear of positive results. 

He also cites embarrassment during pelvic exams, financial constraints and lack of time as common reasons women do not go for cervical cancer screening.

To that last point, Raffles Medical Group's Dr Chng adds: “Time scheduling in the midst of a heavy working schedule frequently causes the patient to forget when the last screening was done.”

A survey by Roche Diagnostics of 3,320 women across eight countries in Asia Pacific revealed similar findings. It found that one in five felt strongly that they have delayed or avoided medical treatment once or several times due to a family obligation.

“It is crucial to address these factors to encourage regular cervical screenings,” notes Dr Wang. “Self-HPV sampling offers convenience and privacy for women, which can potentially increase screening rates.”

In fact, a 2022 study in the Annals, the Official Journal of the Academy of Medicine, Singapore found that most women (84 per cent) favoured self-sampling over physician sampling, indicating that it’s a more comfortable option which can motivate women to take charge of their cervical health.

How to do a vaginal swab on your own

The BMJ, a weekly peer-reviewed medical journal, found that self-collection of one’s vaginal sample for detecting HPV is as accurate as having a clinician do it. 

And, being easy and comfortable, this process makes it more feasible for women to fit regular HPV screening into their wellness routines.

“The swab stick has a red line or mark to show how far to insert it into the vagina,” Dr Ch’ng says. “After inserting the stick up to the red line or mark, rotate the swab gently for 10 to 30 seconds, before removing it.”

To ensure the sample is least contaminated, Dr Chng advises performing the HPV swab two weeks after the start of your menstrual period. Abstaining from sexual intercourse for up to two days before the swab can also improve the accuracy of the sample collected.

Results are usually ready within a week of sending in a sample, and patients will be notified via email or phone.

If the self swab shows the presence of HPV infection, you’ll be referred to a gynaecologist for further assessment, or be advised to consult a doctor to discuss further treatment or management options.

While testing HPV positive means there is an ongoing infection, it does not imply that one has or will develop cervical cancer. Screening lets you detect and address the infection early on, minimising the risks. 

Cervical screening is available at major health screening centres, most primary care and General Practitioner (GP) clinics, and Obstetrics and Gynaecology (O&G) clinics at major private and public hospitals. Women can opt to self-collect their vaginal samples for cervical screening at certain healthcare facilities.

For more information, visit Roche's website here.