Research review 045
Randomised study
Short answer
Offering HPV self-sampling as an alternative to clinician-collected samples increased screening participation in this Singapore trial. Approximately 57 in every hundred participated when offered a choice, compared with 43 in every hundred receiving the standard offer. More HPV infections were also detected. The study was too short to demonstrate a reduction in cancer cases.
What did the researchers investigate?
The researchers studied whether an additional option would encourage more people to participate in cervical screening. The offer concerned HPV testing, which detects a virus associated with the risk of cell changes. A positive test does not mean the person has cancer.
Women eligible for screening were randomly allocated to the standard offer or an offer that also allowed self-sampling. Those offered the alternative could still choose clinician-collected sampling. The effect therefore concerns an offer that provided a choice, not a requirement for everyone to self-sample.
What did they find?
The choice encouraged more people to participate
Screening participation was 56.6% in the group offered a choice, compared with 42.8% under the standard offer. The difference was 13.8 percentage points. Rounded, this means approximately fourteen additional people screened per hundred who received the new offer.
High-risk HPV was detected in 3.1% of the intervention group and 0.3% of the comparison group. The difference refers to the entire groups in the trial. It does not mean that self-sampling caused more HPV infections, but that the offer led to more people being tested and more infections being detected.
Among those actually screened in the intervention group, slightly more than half chose self-sampling. Lower education was associated with a lower likelihood of choosing self-sampling rather than remaining unscreened. The additional choice therefore did not reach everyone equally well.
How certain can we be?
Random allocation and a comparison group strengthen the conclusion about participation. However, participants and staff could not be unaware of the offer assigned to them. Ten of those randomised were not included in the main analysis.
Follow-up lasted only three months. Researchers did not assess tissue-confirmed cell changes as an outcome. More positive HPV samples are therefore an early screening finding, not evidence of fewer cancer cases or deaths. The study also cannot show whether participation remains high at the next screening round.
Who do the findings apply to?
Between August 2024 and February 2025, 650 women aged 30–69 were allocated to the groups. The analysis included 640 women, 320 in each group. They were recruited through primary care, including general practices, in Singapore and were eligible for screening.
Exclusion criteria included pregnancy, previous cervical cancer or precancerous changes, and hysterectomy. Questionnaires were available in English, Chinese and Malay. The trial took place in a relatively well-resourced healthcare system with good access to clinician-collected testing. That matters when comparing results with areas where such access is limited.
What might this mean in everyday life?
The study supports investigating choices as part of a screening service. At the same time, the difference by education shows that simply making an alternative available is not enough. Information, trust and practical support may influence whether people can actually use the offer. The arrangements surrounding the choice need evaluation, not just the sampling kit.
What do we still need to know?
Longer follow-up should establish whether participants receive necessary examinations after a positive test, what cell changes are found and whether they participate again when offered screening later.
Additional support should also be tested for people with less education so that more people have a genuine opportunity to choose and complete the test. Costs must include the entire pathway, including examinations after a positive result, rather than only mailing and analysing self-samples.
Sources
The publication covered by this review
Ng XR, Quek IP, Pereira MJ, Molina JA, Tan KE, Ngeow J et al. Effect of Self-Sampling HPV DNA Testing on Cervical Cancer Screening in Singapore's Primary Care: Pragmatic Randomized Controlled Trial. Annals of family medicine, 2026.
Other studies and professional sources mentioned in the text
Background source: Clinical Validation of a Vaginal Cervical Cancer Screening Self-Collection Method for At-Home Use: A Nonrandomized Clinical Trial. 2025. Read the publication.
Background source: Mailing Vaginal or Urine Self-Sampling Kits versus Conventional Invitation Letters: A Randomized Trial to Assess the Effect on Cervical Cancer Screening Attendance. 2025. Read the publication.
Last reviewed: 30 October 2026.
Source basis: The publication's full text.
Editorial update, 1 November 2026: Language, explanations and references were reviewed. The source-review date is stated above.