From swabs to urine sampling: Rethinking cervical screening in general practice

Today, we’re speaking to Prof Emma Crosbie, Professor of Gynaecological Oncology based at the University of Manchester.Title of paper: Urine human papillomavirus testing for cervical screening in a UK general screening population: a diagnostic test accuracy studyAvailable at: https://doi.org/10.3399/BJGP.2025.0105The switch from primary cytology to primary human papillomavirus testing has enabled innovations in self-sampling for cervical screening. This study shows that urine self-collected with a first-void urine collection device has similar diagnostic test accuracy and acceptability to cervical sampling in a general screening population. Urine self-sampling has real-world potential as an alternative cervical screening option.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.440 - 00:01:07.140Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate Editors of the bjgp. Thanks for listening to this podcast today.In today's episode, we're speaking to Professor Emma Crosby, who is professor of Gynecological Oncology based at the University of Manchester. We're here to talk about her really exciting paper that's recently been published in the December 2025 issue of the BJGP.The paper is titled Urine Human Papillovirus Testing for Cervical Screening in UK General Screening Population A Diagnostic Test Accuracy Study. So, hi Emma, it's lovely to meet you and to talk about this paper.I really just wanted to start off talking a bit around cervical screening in the uk, and you mentioned this in the introduction to the paper as well, that cervical screening really does have variable uptake rates and we know that there are some, some barriers to access. But can you talk us through these and tell us a bit about why you decided to do this research?Speaker B00:01:07.940 - 00:03:41.440So, as you've just really nicely summarised, cervical screening is really important weapon against cervical cancer.So we know that it prevents cervical cancer and since the introduction of the NHS Cervical Screening program in the UK, we've seen deaths from cervical cancer drop by around 70%. So we know that it's very effective.But in the uk, the number of people attending is declining year on year and currently, currently only around 68% of those people who are eligible for cervical screening actually attend. There are a whole range of different reasons for non attendance.These include things to do with the speculum examination, so having to have an intimate examination to be examined. The anticipated embarrassment or fear of pain related to that procedure, I think are important barriers.But there are also barriers associated with access to reaching screening appointments, taking time off work, having childcare and so on and so forth. So we thought that there was some really important barriers there that could potentially be addressed by self sampling.Now, vaginal self sampling is actually been incorporated in many cervical screening programs around the world.Some cervical screening programs are using it just for people who are non attenders or underscreened by traditional screening routes and other countries are using it as a choice for everybody.Now, in the uk, we haven't yet taken up vaginal self sampling sampling, but it will be introduced this year in 2026, principally for under screened groups. And there is some work looking at whether or not it will be introduced as a choice for everyone in the future.But we know from research that's been done in the UK that only around 12 to 13% of people who are offered vaginal self sampling who are under screened actually return a sample. And therefore it clearly doesn't address all the barriers to cervical screening. And we wondered whether a urine test would have more app.It would have the same benefits of vaginal self sampling in that it can be collected at home and posted to the laboratory. So it removes that need for an intimate examination.It removes the need for, you know, making an appointment at a healthcare facility to have your screen taken, but it perhaps, you know, removes some of the barriers towards putting a swab inside the vagina that might be culturally or religiously unacceptable to some groups. And so we thought that a urine self sample could be another option for people who currently aren't screened.And so we wanted to see how accurate it was in this study.Speaker A00:03:42.320 - 00:04:03.760And those issues around access are really important, especially in this population of women who are juggling lots of caring responsibilities with young children or caring for older relatives as well.So sometimes it is just difficult to get to an appointment and, you know, juggling work hours and things which often then coincide with GP opening hours as well.Speaker B00:04:03.920 - 00:04:41.960Yeah, absolutely.And we, we have seen a drop in people, you...