Developing an at-home urine test to revolutionise cervical cancer screening for women around the world

Cervical cancer is the second leading cause of cancer-related death among women worldwide. It is caused by persistent infection with high-risk human papilloma virus or HPV.

Cervical cancer is almost entirely preventable through HPV vaccination and screening. Screening is an intimate procedure that involves insertion of a speculum into the vagina to allow a healthcare practitioner to visualize and collect cells from the cervix using a soft brush.

These cells are then tested for HPV and women at high risk of cervical pre-cancer are referred to colposcopy clinic where pre-cancerous cells are identified and treated, in turn preventing progression to cancer.

In England and Wales, women are offered a free cervical screening test on the NHS every three years between the ages of 25 and 50 and every five years until they reach 65.

Our organised cervical screening programme has resulted in a dramatic drop in the number of women diagnosed with cervical cancer and there are now 70 percent fewer deaths from the disease.

In countries where such screening programmes don't exist, or are not freely available to all, cervical cancer remains a major cause of morbidity and mortality among young women.

Despite its success only around 7 in 10, women in the UK attend cervical screening. Around five million women are overdue their appointment in England and Wales alone. The reasons for this are multiple and complex but include embarrassment fear of being examined and inconvenience, factors that may be overcome by self-sampling.

Self-sampling involves women being sent a soft brush to their home address to enable them to collect cells from the vagina in the privacy of their own home to be to return to the lab for testing.

So-called vaginal self-sampling has been shown to be just as effective as regular cervical screening at detecting HPV and is already available in some countries where its use has encouraged uptake of cervical screening by more women.

In the UK, it is being trialled in a pilot study in London to see whether its use can encourage uptake of cervical screening by women currently overdue their appointment.

Here at The University of Manchester, we are interested in taking self-sampling to the next level by developing urine HPV testing for cervical screening. A urine sample could be collected at home and returned to the lab for testing.

It eliminates some of the barriers to cervical screening that are not addressed by vaginal self-sampling like embarrassment and fear of intimate examination. Following the exciting results of our pilot study that showed that urine was just as good as routine cervical screening at identifying cervical pre-cancer, the National Institute for Health Research have funded a much larger study based in Manchester where we will test urine as an alternative to routine screening and also see whether women who are not currently up to date with their screening appointment would be interested in providing a urine sample instead.

We are very excited to have been awarded the research funding and look forward to getting started. This research is particularly important during the coronavirus pandemic where many places have suspended routine screening altogether to redirect healthcare resources towards fighting the pandemic and to protect patients and healthcare professionals from COVID-19 infection.

A urine test could enable cervical screening to be carried out at home, completely avoiding face-to-face contact. For the vast majority who test HPV negative, this is likely to be particularly important.

For women from ethnically diverse and socially disadvantaged backgrounds, who are at greatest risk of cervical cancer yet least likely to attend screening and now disproportionately hit by COVID-19, by eliminating the need for healthcare professionals to deliver screening, urine HPV testing is likely to be cheaper and a suitable alternative in low-income countries that lack the necessary infrastructure, private rooms, health care staff, sterile medical equipment to carry out routine cervical screening.

The coronavirus pandemic has been an enormously challenging time globally that has forced us to find innovative ways of doing things differently to keep ourselves and our patients safe.

Urine self-sampling for cervical screening could be a fantastic opportunity to reach women who are currently disinclined to attend screening, offer a cheaper and more sustainable alternative to low-income countries and curb the spread of coronavirus infection whilst allowing cervical screening to continue regardless during this and any future pandemic.