Self-sampling in HPV Screening

This is a verbatim transcript of an interview conducted with Dr Ida Ismail Pratt in October 2025. The transcript has been lightly edited for clarity.

Introduction

My name is Dr Ida Ismail Pratt. I am an OBGYN specialist and I work in Singapore, and my special interest is in cervical cancer prevention and HPV-related diseases.

What is self-sampling? What are the benefits of in-clinic self-sampling in conjunction with HPV DNA screening?

HPV self-sampling is a cervical cancer screening test. Traditionally, for cervical cancer screening, a woman will have to visit her doctor and it involves an internal examination. With HPV self-sampling, a woman can actually do her regular cervical cancer screening in the comfort of her own home, by herself and in privacy as well.

So this is an alternative choice for a woman, especially when she finds that she’s not able to go to the GP to get her regular screening done. We all already know that there are barriers for women to go for their regular screening.

The traditional way of cervical cancer screening has its barriers, and one of the main barriers is logistics. Women may not be able to go to their doctor or they have no access to a doctor to do the cervical cancer screening. The traditional screening also can be quite embarrassing for women because it’s an internal examination and it can be giving them a bit of discomfort for the screening itself. With HPV self-sampling, it overcomes all these barriers that is faced by women, thus allowing them to be a little bit more proactive to go for their regular cervical cancer screening.

What are some common misconceptions about self-sampling, and how do you address them?

In March 2025, Singapore has updated our national cervical cancer screening guideline to include the workflow for HPV self-sampling and this allows better access for regular cervical cancer screening for Singaporean women. The survey came about because we were interested to know what is the current practice of cervical cancer screening especially for the primary healthcare providers that works very closely with the community.

So in collaboration between the Society of Colposcopy and Cervical Pathology Singapore, National University of Singapore, and also a non-governmental youth group called the Alliance of Action Against HPV or A4HPV, we performed the survey of about 3,000 GPs and primary healthcare providers in Singapore to ask them about their practice regarding the advice and the encouragement of cervical cancer screening when they see their women.

What we found one of the main reason why primary healthcare providers may not take the opportunity to promote cervical cancer screening in these women is the fact that they are uncomfortable in talking about HPV for cervical cancer screening. One of the misconceptions regarding HPV and HPV test that we found is the confusion among women and also primary healthcare providers, thinking that HPV is a sexually transmitted disease, because this opens up a Pandora box of other questions that most GPs do not feel equipped to answer when the women ask these questions. We need to understand that HPV is a surrogate to predict the risk of cervical cancer in a woman and it’s a better predictor of future cervical cancer than a Pap smear ever will be.

What are some major barriers for implementing self-sampling in primary care?  What recommendations would you have to address these barriers?

I think one of the major barriers for self-sampling would be follow-up, because certainly when we introduce self-sampling to the community, it is very important to understand that it’s not just about handing the self-sampling screening to the women, but we have to have accountability in following up these women especially those who will have a positive cervical cancer screening result. And this is where a collaboration between the community, the healthcare providers, and also the decision-makers and the government is very important. What we have done in Singapore is we have done a campaign to introduce HPV self-sampling in the community in collaboration still with A4HPV, where we brought the HPV self-sampling to the women in the community with community events. We have trained volunteers because this is another barrier in Singapore, is that there is still a lot of education and awareness regarding not only cervical cancer screening but the choices of how to go for your regular screening.

We have teamed up with various clinics and community events to ensure that not only that the screening goes to the women so that they are able to screen where they feel comfortable, but also follow-up is being done by the clinic as well to make sure that all women who has a positive HPV test are being managed appropriately as how they will be if they actually come to the clinic. And the HPV SIMPLE is now being run in Singapore and we are having now about 10 community events throughout the year to continue to encourage women to come for HPV self-sampling.

What are some practical tips for clinics starting to offer self-sampling?

For clinics that would like to adopt the HPV self-sampling method for their women in terms of cervical cancer screening, there are a few tips that can help you. First is to make sure that not only the primary healthcare providers or the doctors, but also their support such as their nurses, are aware of the self-sampling method the benefits of HPV self-sampling, the reason why HPV self-sampling is being offered rather than a physician sampling. Having a patient information leaflet also is helpful. Certainly for my clinic, we do have an information leaflet explaining about HPV self-sampling and also a leaflet on telling the women or counseling the women in terms of what will happen if your HPV test comes back as positive. This helps the women to alleviate the anxiety for the women as well. Another important factor regarding offering HPV self-sampling in your clinic is follow-up.

I do find that it is very helpful when the women come to the clinic requesting for HPV self-sampling, for them to do the HPV self-sampling actually in the clinic, either in a private room or they can go to the toilet to perform and hand over the self-sampling back to you in the clinic.

Certainly you can offer the HPV self-sampling for them to do it at home, but you will need to have a system in your clinic to follow up these women to make sure that they did do the procedure and also how to send it back to your clinic and a way to inform these women if they have a positive HPV test.

What recommendations would you have for primary care doctors in other Asia Pacific countries to consider adopting self-sampling?

HPV self-sampling is a good alternative to encourage women to go for their regular cervical cancer screening. It’s a paradigm shift in access because now it can overcome most of the barriers of the traditional cervical cancer screening. We now are able to bring screening to the women rather than the women having to seek screening themselves.

And this HPV self-sampling has been rolled out in many countries. For physicians who would like to adopt HPV self-sampling, it is a method that is being encouraged now, but I would recommend that you do have to understand the test, you do need to  understand the HPV and its implication in terms of cervical cancer screening and also the implications when you have an abnormal HPV test. Only then you will be able to better counsel your women and encourage them to go for cervical cancer screening.

Cervical cancer is not just a women’s problem, it’s everybody’s problem. So to be able to introduce HPV self-sampling successfully to the community, there has to be collaborations not only for the women, but the community, healthcare providers, and also decision-makers such as the government and policymakers.

The views and opinions expressed by Dr Ida Ismail Pratt are her own views and opinions. Roche disclaims all liability in relation to these views and opinions.