YouScreen V1.0
Research type
Research Study
Full title
YouScreen: A pragmatic implementation feasibility clinical trial of offering HPV self-sampling to cervical screening non-attenders within the NHS cervical screening programme in England
IRAS ID
264776
Contact name
Anita W W Lim
Contact email
Sponsor organisation
University College London
ISRCTN Number
ISRCTN12759467
Duration of Study in the UK
1 years, 7 months, 31 days
Research summary
Research Summary: In England, cervical screening uptake has been falling for 21 years. London consistently has the lowest uptake nationally. Underscreened women are at the highest risk of cervical cancer. A potential solution is to offer self-sampling for HPV (human papillomavirus) testing: women can take their own sample, in private and at a time and place of their choice.
Research has shown that offering self-sampling increases uptake in non-attenders and that self-samples have similar accuracy to conventional (clinician-taken) samples. Uptake has been highly variable between studies and likely to differ between settings.
To date, all UK studies have been done outside of the national cervical screening programme. Self-samples have not been recorded in the national screening database and not counted towards uptake (and GP financial incentives) and therefore had suboptimal uptake.
A challenge with introducing new tests is establishing robust pathways for accurately identifying the relevant population, recording and reporting results. This will be an implementation feasibility project of offering self-sampling to non-attenders in 5 Clinical Commissioning Groups with the lowest uptake in North and East London. All 212 GP practices will be invited to take part. The target population will be women at least 6 months overdue cervical screening. Kits will be offered in two ways: (i) a systematic offer – women at the 15 month anniversary of their last test due date without being screened will be mailed a kit (ii) an opportunistic offer in GP primary care – GPs, nurses and Healthcare assistants will be asked to offer eligible women kits when they consult for any reason.
The project will serve to test the new pathways for delivery, generate lessons to help ensure a smooth transition to a wider roll-out and provide the evidence-base for implementing self-sampling at scale.
Summary of Results: The YouScreen trial was a research study that offered at-home self-sampling kits for cervical screening to women and other people with a cervix who were overdue for their screening test.
Cervical screening can prevent cancer by finding early changes in the cervix before they become serious. London has the lowest cervical screening uptake in England, and people who miss screening are more at risk of developing cervical cancer.
The study took place in 133 GP practices in North London during 2021. The aim was to see whether offering self-sampling kits through GP practices, or sending them in the post, would encourage more people to take part in screening, and what impact this would have on screening participation.METHODS
People were eligible if they were aged 25–64 and at least six months overdue their screening. Kits were offered in two ways:
• At GP practices – offered when people came in for any reason (an “opportunistic offer”).
• By post – sent directly to people who were still unscreened 15 months after their routine invitation.We measured:
• Activity: how many non-attenders were screened each month.
• Coverage: the overall percentage of eligible people up to date with screening.
• Uptake: how many kits were returned within 90 days.
We also looked at how many people with abnormal results went for follow-up, and how many had significant cell changes (called CIN2+), which usually need treatment to prevent cancer.RESULTS
Between January and November 2021, 8,338 people returned self-samples.
Uptake:
• 56% of those who accepted a kit in person at the GP returned it.
• 13% of those sent a kit by post returned it.
• Most samples were sent back within a week.Impact on screening:
• The intervention led to a 12% increase in non-attenders screened each month.
• Coverage at participating practices rose by 1.6 percentage points compared to practices not offering the kits. Over a full 3-year cycle, this would mean a 7% increase in coverage.Who took part:
• Half of those who returned a kit were more than two years overdue, including some who had never been screened before.
• Around two-thirds were from ethnic minority groups or from the most deprived neighbourhoods, showing the approach reached people who are often underserved.Follow-up:
• Almost 9 in 10 of those with a positive result attended follow-up within six months.
CONCLUSION
Offering self-sampling kits at GP practices made it much easier for people who were overdue to take part in cervical screening. Uptake was almost five times higher when kits were offered in person compared with posting them out.
The trial showed that self-sampling can increase screening coverage, reach people who don’t usually attend, and could help reduce inequalities. If used nationally, this approach could significantly boost cervical screening in England and help prevent more cases of cervical cancer.
*Evidence from YouScreen directly underpinned the UK National Screening Committee’s decision in March 2025 to recommend HPV self-sampling to be made available as an option for people who do not attend routine cervical screening. Building on this, in June 2025 the Department of Health and Social Care announced that self-sampling will be rolled out nationally as part of the cervical screening programme.
REC name
West Midlands - South Birmingham Research Ethics Committee
REC reference
20/WM/0120
Date of REC Opinion
28 Apr 2020
REC opinion
Favourable Opinion