One quarter of eligible women are missing regular screenings. Their reasons for not doing so are many, but advocates say a self-test procedure would help.

Labour minister Kiritapu Allans words could have been those of thousands of other women who fall through the cracks when it comes to regular cervical cancer screenings.
Im one of those gals that hates anything do with down there. And have taken a see no evil, hear no evil type approach to that part of my body, wrote Allan in a Facebook post telling the world on Tuesday morning that she has cervical cancer.
Time passes. Work piles on. Going to the doctor for anything other than an emergency goes way down the priority list, she added.
Now, Allan is facing a fight for my life with the cancer at stage 3.
Labour minister Kiritapu Allan revealed her diagnosis on Tuesday and has taken medical leave.
READ MORE:* Women keep dying of preventable cervical cancer while self-test screening delayed * Professor Bev Lawton fighting for change in New Zealand’s ‘flawed’ maternity care system* Less than 15 per cent of Kiwi women with cervical cancer regularly screened
New Zealands current screening programme calls for a smear test every three years for women aged 25 to 69 years. And it has been successful, reducing incidences of cancer by 50 per cent and mortality rates by 60 per cent since the programme was introduced in 1990.
However, only three-quarters of eligible women are being screened with Mori, Pasifika and Asian demographics less likely than European New Zealanders to have regular screenings.
It is a system failure that women dont want to get a cervical cancer screening, said Professor Bev Lawton, director of the Centre for Womens Health Research at Victoria University in Wellington who is advocating for a self-test procedure to be common practice in New Zealand. We just have to have a test that suits them.
The current smear test involves a medical practitioner plying the vagina slightly open with a plastic or metal speculum and sweeping a small brush inside to pick up cells for lab testing. It can take minutes and shouldnt be painful (although it can be if care is not taken). But still, the very mention of the procedure can cause legs to cross and eyes to roll.
A vaccine for HPV or human papillomavirus virus, the cause of the vast majority of cervical cancer cases, coupled with regular screenings has made cervical cancer almost entirely preventable. The HPV vaccine rollout started in 2008 and is free for males and females between nine and 26 years of age.
For women in general, and particularly for Mori, a smear test, or just the thought of one, can cause whakam, a feeling of shame and embarrassment, said Lawton. Often that part of the body is considered tapu, or sacred and restricted.
Nobody likes having us there, said Lawton.
Of the 72 per cent of eligible women who are screened each year, 78 per cent of European New Zealanders access a smear test, according to the latest figures from the Cancer Society. Only 62 per cent of eligible Mori, 69 per cent of Pasifika and 59 per cent of Asian women get a smear test.
Cost is a factor, wrote Janet Skilton, a spokesperson for the Cancer Society, in an email. If you have your smear test done at the doctors there is the consultation fee.
Some clinics do provide free smear tests, Skilton wrote, adding that the news of Allans diagnosis on Tuesday spurred a rush of traffic to the Cancer Societys website and its page on cervical cancer.
Transport to a smear test can further add to that cost, said Rose Stewart, the national nurse advisor at Family Planning, an organisation with clinics around the country that provide smear tests. Those in lower socio-economic brackets are also more likely to live in rural areas with limited access to transport, some driving hours for the procedure.
Pathologist David Roche at Southern Community Laboratories examines the results of a cervical smear.
They tend to get health care only if they are sick, said Stewart. A routine screen seems to be at the bottom of the list because youre not noticing anything like if you had a bad toothache.
There is also be a small group of non-binary people and trans men who might feel alienated by feminised messaging about cervical cancer as well as by the procedure, a reminder of the disconnect between gender identity and body.
You need a very thoughtful service for trans men who need a smear test if they have a cervix, Stewart said.
Lawton is among many who are advocating for self-testing to be commonplace. She also wants to see New Zealand follow the UK and Australia by adopting a new type of test that can happen every five years rather than every three like the current smear test and could prevent 15 per cent more cervical cancer deaths.
The self-tests can either be done at home or in the bathroom of a doctors office and are far less invasive than the current smear test.
Pop a swob in the vagina, move it around only a little, put it into a tube, and it goes to the lab, said Lawton.
In a 2020 study conducted by Lawton, 73 per cent of 500 Maori women who had either never had a smear test or had not had the procedure done regularly said they were willing to do the self-test. However, funding for the self-test has been delayed numerous times, and will lead to more unnecessary deaths, Lawton said.
Not only is the self-test less invasive and completed without the presence of another person, but it can also eliminate the time and cost of going to a smear test if done at home.
Weve dropped them off into letterboxes. Weve done all sorts of things, said Lawton.