Screening yourself for cervical cancer could be a game changer, with Dr Anita Lim

[00:00:00] Cervical cancer is one of the most preventable cancers that we have.

[00:00:04] This is Dr Anita Lim. She's a cancer epidemiologist at King's College London.

[00:00:09] And that's super important because at the moment it causes, I think it's the fourth most common cause of cancer in women globally.

[00:00:18] In the UK, there are about 3,000 new cases of cervical cancer every year. Unlike ovarian cancer, we know a lot about cervical cancer.

[00:00:28] Starting with how to prevent it.

[00:00:30] We have a vaccine because we know that it's a virus that causes almost all cervical cancer, so that's a really powerful way of being able to prevent cancer.

[00:00:41] And then the cervical screening. It's effective, but here's where it gets complicated.

[00:00:52] From a patient's point of view, this is what we do when we get screened.

[00:00:56] We go to a doctor's office. We get on the examination table.

[00:01:00] We're half naked, under a sheet, legs apart, feet in stirrups.

[00:01:04] And here comes the speculum. Open wide.

[00:01:09] And then the doctor gets a long, tiny white brush and inserts it into our cervix and takes a sample.

[00:01:17] What's commonly known as a scraping.

[00:01:20] I think there is something also to be said about the language that we use because for some people, maybe those words are not very helpful.

[00:01:28] They're a bit off-putting.

[00:01:29] The whole thing can take a couple of minutes, but feel like someone has just turned you inside out.

[00:01:35] No? Just me?

[00:01:37] Some women are totally fine with it, that it's just a little bit uncomfortable.

[00:01:42] And for other women, it can be really, really challenging.

[00:01:45] You know, I've heard about women who actually have to undergo a general anesthesia just to get basic tests done, which is, you know, it's really unacceptable in some ways.

[00:01:55] It is not surprising then that there's a drop in the number of women showing up for cervical screening.

[00:02:01] That means fewer women taking the steps we know can help prevent cervical cancer.

[00:02:07] I mean, it's wonderful that we've got now an option that you don't have to do that and you could do something else.

[00:02:12] And that something else is self-sampling.

[00:02:15] In the privacy and comfort of your own home, it is possible to do your own cervical screening test.

[00:02:21] People have got it so ingrained in their minds that the doctor needs to look at your cervix.

[00:02:25] They say, oh, yes, that looks good.

[00:02:26] And, you know, there's some reassuring noise and it's this whole procedure.

[00:02:29] And therefore, how can it be that suddenly I could just take this swab test myself and I'm not a health professional and it's still a good quality test?

[00:02:36] And so that's part of the PR that we need to get out there for self-sampling to just reassure people that you are going to take a good quality test.

[00:02:46] First, Anita Lim was the lead researcher on a major study in the UK called the UScreen trial, which released its results earlier this year.

[00:02:55] It reached out to almost 30,000 women to find out if self-sampling could be effective.

[00:03:04] This is Overlooked and I'm Golda Arthur.

[00:03:07] In this episode, we're talking about cervical screening and you'll hear more about what an at-home DIY screening test is like.

[00:03:15] Dr. Anita Lim talks about that huge study and the obstacles she had to push through to make it a reality, as well as her work as a cancer epidemiologist.

[00:03:25] That's all coming up after a quick break.

[00:03:30] Hi, I'm Dr. Sarah Finlayson, a gyne-oncologist with the Gynecologic Cancer Initiative.

[00:03:35] The Gynecologic Cancer Initiative is a British Columbia-based team committed to transforming research and helping women understand, prevent and survive gynecologic cancers.

[00:03:47] From precise diagnostics to innovative prevention strategies and groundbreaking clinical trials, we are already driving change.

[00:03:57] I'm Joan from Surrey BC. I'm a stage 4 uterine cancer survivor.

[00:04:02] I'm very privileged to be able to work with the GCI to help other women through research programs.

[00:04:07] It took nearly a year for my wife to be diagnosed with stage 4 high-grade serous ovarian cancer.

[00:04:14] With GCI's ongoing work and assessments, testing and raising awareness of gynecancers, I hope physicians will prioritize the possibility of gynecologic cancer during patient assessments to improve diagnostic times.

[00:04:29] Discover how you can join our mission and be part of the change at gynecancerinitiative.ca.

[00:04:41] Hi, Anita. Welcome to Overlooked and thank you so much for talking to me for this episode.

[00:04:46] Let's start by talking about cervical cancer. How much do we actually know about it?

[00:04:50] We understand a lot about cervical cancer and the ways that we prevent it.

[00:04:55] So human papillomavirus, we know that it causes almost all cervical cancers.

[00:05:00] And we have a vaccine that actually to vaccinate against the HPV virus.

[00:05:06] And we also know that screening works.

[00:05:08] With cervical screening, this is something that has been going on since the 80s, more or less, or even a bit earlier.

[00:05:13] There was in the 1960s when the first cervical screening test was developed.

[00:05:18] And it used to be that you get cells from the surface of a woman's cervix or a person with a cervix.

[00:05:24] You get cells from there and you look at it under a microscope.

[00:05:27] And now what we look for, instead of looking for the cells in the first instance, we look for presence of the HPV virus.

[00:05:34] So we look for the DNA of the virus.

[00:05:36] And it's that element that allows us to test self-something.

[00:05:40] So what I'm picturing in my mind, and I want you to correct me if I'm wrong, is something not unlike a COVID test, right?

[00:05:48] Where we've been swabbing our noses in order to test for a certain virus there, right?

[00:05:53] Have I got the right picture or is this something completely different?

[00:05:56] You have got exactly the right picture, but in a different anatomical part, right?

[00:06:00] So basically it is that.

[00:06:02] So what we used in the U-Screen trial, which is what I led the investigation of, is we used what looks like a very long cotton swab.

[00:06:09] And a woman would just need to insert that gently into their vagina and twirl it around for 20 seconds and take it out.

[00:06:17] And that's your sample done.

[00:06:18] So it is very, very easy to do.

[00:06:21] You don't need to touch your cervix.

[00:06:23] You don't need a speculum, you know, the instrument that they use to hold the walls of the vagina open.

[00:06:27] You don't need, you know, someone to have that sort of very, very intimate examination, which a lot of people do find uncomfortable or painful.

[00:06:34] And you can just do it in a few minutes.

[00:06:36] There's no getting around it.

[00:06:38] It is incredibly uncomfortable.

[00:06:39] What is the problem then that we're trying to solve with at-home tests?

[00:06:45] What we're looking for within cervical screening, it's not, a lot of people think it's you're looking to try and pick up a cancer and then treat earlier.

[00:06:51] It's partly that, but what it is mostly is what we call primary prevention, whereby it's a slow growing thing.

[00:06:58] So you're looking for an abnormality on the cervix that could be treated.

[00:07:03] And if you didn't treat it, it would go on and develop into cancer.

[00:07:06] So you're looking to prevent the cervical cancer from developing in the first place.

[00:07:10] The problem that we're trying to solve is what's been happening in the UK, at least for about 20 years, is that the numbers of people,

[00:07:17] the proportion of people who are coming for their cervical screening has been falling.

[00:07:21] It's a longstanding decline.

[00:07:23] And in London, we have almost 50% of women who are not coming for their cervical screening.

[00:07:28] And, you know, it's so important that we have approaches that we can get more people screened so that we can protect them from developing cervical cancer.

[00:07:38] So that's a big number, right?

[00:07:39] 50%, as you said.

[00:07:41] And I'm curious, the people not showing up for screening, can you say, well, it's a generational thing?

[00:07:46] Is it younger women?

[00:07:47] Or like, what do we know about why this number is falling, the number of women showing up for cervical screening?

[00:07:54] So globally, I think in developed countries, I think the research is very, very showing similar things that it is about the intimate nature of the test

[00:08:01] and having to have that very private examination, that there's a real fear or worry or embarrassment factor that is very strong within a barrier for people to not come.

[00:08:10] So what we see in the UK certainly is that the uptake in younger women, so when I say young women, I'm saying like women between the ages of 25 and 35 or so, or even 49, actually, because we cut the, we look at those age groups, tends to be lower.

[00:08:24] So what we think is what we hypothesize is that for young women, I think it's probably that they are a bit more embarrassed, like that they, a lot of them haven't had a gynecological examination before.

[00:08:36] So they're quite off put by that.

[00:08:37] And one thing that floats about, and this is just a hypothesis as well, is that cervical screening has been a victim of its own success, that it's actually relatively rare.

[00:08:46] You know, that a lot of people don't necessarily know about cervical cancer.

[00:08:49] People might think that if they've had the vaccine, they might think, well, I don't need to be screened anymore.

[00:08:54] And so there's a bit of maybe some misinformation, low awareness that plays into that, I think, in young women in particular.

[00:09:00] And then we've got also old women.

[00:09:02] We also find that there are potentially issues of low awareness whereby I've had my children, I've had the same sexual partner now, I've not got a new partner.

[00:09:11] I don't need to be screened because I'm not sexually active or whatever it is.

[00:09:15] And so part of it is awareness.

[00:09:17] So just to be clear then for those listening, if you've had the HPV vaccine, you still need to be screened, right?

[00:09:23] You do.

[00:09:24] I mean, that's what the current guidance would say.

[00:09:26] And that is because the vaccine protects against, it doesn't protect against all cervical cancer.

[00:09:31] So there's lots of different HPV types.

[00:09:33] I think the current estimates are about that it protects against 90%, depending on which vaccine you have.

[00:09:39] Okay, so tell me about the U-Screen trial.

[00:09:42] There are a couple of unique things about the trial.

[00:09:45] The first one is that it's the largest self-sampling trial to be conducted in the UK to date.

[00:09:50] The second is that it's the first time that self-sampling was integrated into our national health service.

[00:09:56] That was one of the key things that we wanted to do within the U-Screen trial is start to build the evidence base for wider rollout and just demonstrating that it works.

[00:10:07] So policymakers can make a clear decision on that.

[00:10:10] The other thing to note about the UK is that, you know, obviously we've got a national health system and screening is organised.

[00:10:16] So women are actually formally invited to their screening every three or five years, depending on their age.

[00:10:22] And there's a system that goes to remind women to come and to invite women to come.

[00:10:27] For the U-Screen trial itself, we invited over 27,000 women who were overdue for their cervical screening.

[00:10:35] So these are the women that we know are at highest risk of developing cervical cancer.

[00:10:39] And we distributed self-sampling kits to these women in two different ways.

[00:10:48] So the first way was a direct mail-out.

[00:10:51] So we have a centralised database of all people who would be eligible for screening and are invited.

[00:10:56] When they had a certain time point of being invited but not showing up, they would receive a letter and then a kit in the post.

[00:11:03] And then they could just return that kit.

[00:11:09] And the second way that we did it was that we got GP practices.

[00:11:12] So we've got primary care in the UK where we've got a primary care health system where almost all of our cervical screening is delivered by that primary care health system.

[00:11:21] So people go to their doctor. That's your first point of call.

[00:11:23] People who turned up who are overdue for their screening for any reason when they turned up, they were offered a kit.

[00:11:32] And what we found is that if you mail out kits to women, self-sampling kits to women who are overdue for their screening, we found that 13% of women would return a kit.

[00:11:41] So there's a woman who haven't previously come and that they're not coming.

[00:11:43] And if you offer it in the GP practice, that 56% of women would return a kit.

[00:11:49] And the options for when you get it at your GP practice is you can do it in the bathrooms there or you can take the kit home.

[00:11:55] And I think why we saw much higher uptake at the GP practice is because you get the chance to ask questions.

[00:12:01] You know, you've got your doctor, your healthcare professional there recommending you this test.

[00:12:05] And so it's a bit more explained, I think, is one of the reasons why we think that we saw such much higher uptake there.

[00:12:16] What were the implications then of these results?

[00:12:18] So the implications were what we did is we estimated what the impact would be over a screening round.

[00:12:24] And we found that you would increase screening participation by 7.4% if you offer self-sampling to non-attenders over one screening round.

[00:12:34] And this we estimate to be that you would get 1 million more women in England screened.

[00:12:40] So that would be, we've estimated for three years.

[00:12:42] And that's really huge because, you know, people have been trying to get increased screening uptake for years.

[00:12:49] You know, we've just not been able to do that.

[00:12:51] And self-sampling, people have always held it as a game changer because it is able to address so many of those classic cervical screening barriers.

[00:12:59] So tell me about the challenges of putting a trial like this together and running it or any pushback.

[00:13:07] I mean, I imagine there must have been pushback from somewhere, right?

[00:13:10] I'm laughing because we did have a huge amount of pushback.

[00:13:14] So this trial has been the absolute pinnacle of my career in the sense of it has been the most challenging piece of work that I've ever done because we've got a really high quality screening programme in England.

[00:13:25] And to make changes to that, they're hesitant because they need to be very sure that it's safe, that it's effective, that it's accurate.

[00:13:31] And then there's obviously bureaucracy that goes with it as well.

[00:13:34] And I think it took us two years to get the screening programme to actually agree to let us do the trial.

[00:13:38] So it took a long time to get that across the line.

[00:13:42] It does sound incredibly challenging, but bring that to life for me.

[00:13:47] Can you tell me about maybe a moment in time where you really found that you had to stretch yourself to rise to that challenge?

[00:13:54] So when this Uscreen project came about, I was, I'm going to say like a relatively junior researcher at the time, but the opportunity came up to do it.

[00:14:08] Up until then, I'd not really had many interactions at that very big stakeholder level.

[00:14:14] And because we were coming up against so many blockers, I really had to find something within myself to just go and lead and be the spearhead of this project and just drive it forward.

[00:14:23] And particularly when, you know, you've got all these like constant no's and pushbacks to just go, OK, well, Anita, now you're just going to have to go and take this forward because it's important and you're just going to have to do it anyway.

[00:14:33] And there was one key meeting that we had where we had to convince some very important stakeholders to allow us to do the study.

[00:14:40] And it had been, I don't know, like 18 months of conversation.

[00:14:44] So to get permission to do that study in order to get the OK to put it into the NHS.

[00:14:50] Yes. And it had taken so long to get to this point.

[00:14:53] And it all kind of came down to this key meeting.

[00:15:00] The way that I prepared myself, so me and another gynecologist were to give a presentation and we wanted to come out of that meeting with a yes.

[00:15:08] So I'd been reading a book by Chris Voss, which is an ex-FBI hostage negotiator.

[00:15:13] And I was looking at his top tips there and we engaged all of those tools.

[00:15:17] We used those ex-FBI hostage negotiator tools to get, actually the answer is to get the no, but it's the yes.

[00:15:24] You know, it's like, would you be against this?

[00:15:26] And it totally worked, but it was a huge milestone for us because it had taken, you know, a year and a half to get to this point just to start planning properly for this study.

[00:15:39] So that was important for me in my career in the sense that I'd felt like quite a junior researcher before and I had to really just come into my own.

[00:15:47] You know, this was the beginning of it because Uscreen was very challenging to do and a lot of people said it could never be done.

[00:15:53] And, you know, we went and we did it anyway, which is a wonderful thing to do, you know, just to have that tenacity to do it.

[00:16:00] But that was the beginning of it for me.

[00:16:03] I think after we did that, I knew that we could take on anything because that was so difficult to get over the line.

[00:16:12] But the other thing that was hugely challenging is that the screening programme itself was changing.

[00:16:16] So they were changing providers for how they do their letters.

[00:16:19] They were changing the laboratories for how they do the testing.

[00:16:23] So there was a lot of system changes.

[00:16:25] And we had the trial in these areas of London that have got very poor uptake.

[00:16:29] And just to get the GP practices, how to get them on board to doing that, that was very, very challenging.

[00:16:35] And then the big one was COVID.

[00:16:37] You know, we just got our green light to go for it and then COVID hit.

[00:16:41] So we set the whole thing up working from home.

[00:16:43] So we were working from home.

[00:16:45] The laboratories, a lot of them were working from home.

[00:16:47] A lot of the GPs working from home.

[00:16:49] So we had to change the design slightly.

[00:16:51] But, you know, that was a crazy period for everyone.

[00:16:54] But then, Anita, I'm just trying to imagine, like, so, you know, you had this long lead up to it.

[00:16:59] You had these challenges setting everything up.

[00:17:02] Then the pandemic.

[00:17:03] And, you know, this would have taken place, firstly, a large study over several years.

[00:17:09] What was it that kept you pushing through this?

[00:17:12] I think it must take some real will, you know, one way or the other, professionally or personally, to say to yourself, I'm going to see this through.

[00:17:20] Like, what kept you going through that?

[00:17:22] Yeah, I mean, that's a really interesting question because I've actually reflected on this myself.

[00:17:25] And I can tell you that the thing that kept me going is very early on in my career, I guess I had the privilege of hearing stories from women.

[00:17:34] I've almost always exclusively worked in gyne cancers.

[00:17:37] And I got the opportunity to speak to people who have been diagnosed with ovarian cancer and cervical cancer.

[00:17:42] And their stories really stuck with me throughout my whole career.

[00:17:49] But there's one person in particular that I found has really had a lasting impact and impression on me.

[00:17:54] And that was someone who I worked with.

[00:17:56] She was a patient and public representative for a research project I worked in with cervical cancer.

[00:18:01] And after one project meeting, she turned around and said to me, oh, it's really annoying.

[00:18:05] I've just had a routine checkup because she'd already cleared her cancer.

[00:18:08] She's in her early 30s.

[00:18:09] And she said, oh, I've had a routine checkup and they picked up a spot on my MRI.

[00:18:14] And so now I have to go in and get checked.

[00:18:15] And she said, oh, it's so annoying.

[00:18:20] And then six months later, she died.

[00:18:22] And I found that really, it really affected me.

[00:18:25] You know, she had two twin babies that she left behind.

[00:18:29] And I mean, you can hear me now that I do feel very emotional about it because whenever I've experienced any challenges in my work,

[00:18:36] because academic research is quite challenging in the sense of like, you're not in it for the money.

[00:18:41] You're in it for impact.

[00:18:43] You're in it because you care.

[00:18:44] And it can be, you know, it's like studies on a shoestring budget or something.

[00:18:49] And just whenever there were challenges, which we had a lot of in this particular trial, I've always thought about this person.

[00:18:55] Because when you're asking, why am I doing this?

[00:18:57] You know, why do I bother?

[00:18:58] Should I just give up now?

[00:18:59] And you think, OK, I'm doing it for her because it's so important, you know, that you can make a difference and you can help, you know, make sure that no one else has to go through that.

[00:19:13] Thank you for sharing that story with me.

[00:19:15] I know that sometimes the simple questions lead to the biggest answers and that they're hard to share.

[00:19:20] Right.

[00:19:21] When we talked on the phone as well, I think you let me know about some of the feedback and comments you received from women in the study, which I'm also curious about.

[00:19:30] Was there any that you want to bring to mind now that either shaped how you think about things or maybe changed certain things that you did?

[00:19:39] What did women tell you who were actually using these kids?

[00:19:42] So the feedback that we had from the study, like a lot of it was very positive.

[00:19:46] So women, some women were really excited.

[00:19:48] They thought it was such an amazing sort of like new innovation that they were really excited about.

[00:19:52] And some women were really grateful, like just like you've taken a huge burden off my shoulders because people who have not wanted to go through the screen, but they knew that they had to, but they just didn't want to have that test.

[00:20:02] And I mean, the surprising pieces for me is just really, again, it's the stories, isn't it?

[00:20:06] Like hearing people's stories as to why they don't want to have that test.

[00:20:09] Some people have got some very harrowing stories as to why they don't want to go.

[00:20:13] And you can totally understand, OK, yeah, I wouldn't go either if I was you because of like all these things that have happened.

[00:20:19] So you can see that there's a real unmet need there.

[00:20:22] I guess one thing to mention as well that I'd like to mention is I know that trans men, for example, that cervical screening can be really difficult for them because they don't necessarily want to engage with their female genitalia.

[00:20:33] And so giving them something else which is a bit more easier for them to undergo, then that's a big win as well to be able to open the doors so much for people who are currently underserved.

[00:20:44] In terms of the emails that I received, there is one person as well that I found particularly touched by.

[00:20:48] So I was actually emailed by a lot of people who've undergone sexual abuse or have post-traumatic stress syndrome from other things that just make it really they don't want to go and have this sort of examination done.

[00:20:59] And there's one person in particular who I exchanged a couple of emails with.

[00:21:03] Like, first of all, she was just asking, oh, can you please tell me if it's true that there is just this test because I've asked my GP and they said I've never heard of it.

[00:21:09] Just so desperate to get hold of a test and eventually she emailed me later on and she said, oh, look, just to let you know the reason why I don't want to go is because, you know, of this horrific abuse.

[00:21:20] And she said to me an email that she'd rather die than have someone touch her to have that examination done.

[00:21:26] And so I was thinking, oh, there's such a need here, you know, and even though there might be small numbers for that, it's so important that we can start to address some of these needs that are just unmet because we have a tool for it now, which is really amazing.

[00:21:38] You know, now that I think about it, I sort of, why didn't we think of this before?

[00:21:43] Which must mean it's a good idea, right?

[00:21:45] Because it just seems like a, yeah, we need this.

[00:21:48] We totally do need it.

[00:21:49] And as I was saying earlier, like the reason why we couldn't do it before is because when the test was done that you actually need to take cells from the cervix, the neck of the womb, then you need to be able to access it with the speculum.

[00:22:01] But if you're just looking for DNA, you know, sometimes I say CSI, you know, like they're going to find you, you know, they just need a little bit to find the DNA of the virus.

[00:22:09] Then you don't need to touch cervix.

[00:22:11] You can just take a swab or a little brush and then you'll get a good sample.

[00:22:14] Yeah.

[00:22:15] Because, you know, in my mind, for better or worse, I associate the difficulty of a test with a rigor in some way or like a certainty of a result.

[00:22:25] Right. And so when I was just researching this story, I was thinking, but wait, like if all you need to do is a very quick swab, how do you know?

[00:22:34] Like, what are you getting?

[00:22:35] How is that useful scientifically?

[00:22:38] You know, what is the point of that?

[00:22:39] Because in my mind, I was hung up on the word scraping.

[00:22:42] Right.

[00:22:42] It's like, don't make me scrape my own cervix here.

[00:22:45] Right.

[00:22:45] But this makes a lot of sense now that you explain it in this way.

[00:22:49] This is always something that is, I think, quite poorly understood because it's like layers.

[00:22:53] Right.

[00:22:53] What you're looking for is the presence of the virus.

[00:22:56] So if you have an HPV infection, it's not a bad thing.

[00:22:59] You know, it's very common.

[00:23:00] Most women will have it in their lifetimes at some point.

[00:23:03] You wouldn't even know about it because there's no symptoms of it.

[00:23:05] You know, but if you've got an infection there, then it tells us, OK, let's look at the cells on your cervix to see if there's any abnormalities there.

[00:23:13] Now, so the second test after a cell sample is that you would need to go and have your standard cervical screening test because in that sample,

[00:23:21] they will also take the cells from the cervix and they can look at it under a microscope and they can see if there's any abnormal cells there.

[00:23:29] And if there are any abnormal cells, then they'll say, go and see a gynecologist or we call it a colposcopist who will use a special microscope and have a very good look at your cervix and see if there's anything that looks like.

[00:23:41] Maybe we want to remove that little piece of tissue because it could go on to develop into cancer.

[00:23:46] So it's a series of tests.

[00:23:47] That's an important thing to understand.

[00:23:49] And I do take your point of like, I think people have got it so ingrained in their minds that the doctor needs to look at your cervix.

[00:23:56] They say, oh, yes, that looks good.

[00:23:57] And, you know, there's some reassuring noise and it's this whole procedure.

[00:24:00] And therefore, how can it be that suddenly I could just take this swab test myself and I'm not a health professional and it's still a good quality test.

[00:24:07] And so that's part of the PR that we need to get out there for self sampling to just reassure people that you are going to take a good quality test.

[00:24:16] OK, well, so here's my selfish question.

[00:24:18] When are we going to get this test widely distributed in America?

[00:24:22] So I had to look into this for America.

[00:24:24] So I know I definitely know that there's a lot of interest in the U.S. and that there are research studies.

[00:24:28] So there was one big clinical trial that was conducted.

[00:24:31] I think it was in Washington, but they basically they looked at doing a mail out test.

[00:24:35] So they randomized to between sending people a kit in the post or asking them to order a kit or just to have an education about why you should come for your screening.

[00:24:44] And they found that an additional 14 percent of women would come.

[00:24:47] So these are women who haven't been coming that they invited to their trial as well would come if you offered a mail out kit.

[00:24:54] So that was a very positive study in the sense that like you do see an increase in uptake there.

[00:24:58] And I know that there's something called the Last Mile Initiative that has been specially set up that you might have read about that as well, where it's some sort of like between public and regulator type bodies have come together to try and build the evidence base, get the evidence base that will allow self sampling to have the FDA approval to go on to be used within the U.S.

[00:25:19] So I don't know the timeline, but I think it is very positive and very exciting that they have actually gone to the effort of putting that together because they see there's a need.

[00:25:27] They need to get over the line.

[00:25:29] And this is what they're doing to get over the line and implemented.

[00:25:52] What in your mind is the most overlooked aspect of what we've been talking about today?

[00:25:58] And where is that inequality felt most deeply?

[00:26:04] So I think the most overlooked aspect of cervical screening and cervical cancer in general is that it is so preventable.

[00:26:11] And I would really encourage people to go and read about human papillomavirus and cervical cancer because there's no reason why you should not protect yourself.

[00:26:20] And it is so simple to do.

[00:26:22] It can be a really life-saving test.

[00:26:24] And I know that there's inequities.

[00:26:26] Cervical screening has always had inequities.

[00:26:28] Cervical cancer has inequities.

[00:26:29] We know that in ethnic minority groups, and particularly in women with a black background, that they're going to have worse outcomes.

[00:26:36] And I think self sampling, one of the cool things about self sampling is that it looks like very promising in terms of an approach for starting to address the inequalities we have.

[00:26:46] Because if you make screening much more accessible and you make it easier, then you've got a really good opportunity to get more women screen because you're meeting them where they are.

[00:26:57] Well, listen, thank you for what you did and you and your researchers and everybody who works inside women's health to push innovation along because we sure need it.

[00:27:07] So thanks so much again for making the time to talk to me today.

[00:27:10] Thanks so much, Golda.

[00:27:11] And I must say thank you so much to my – I had an amazing team that worked with me for the YouSkin project and all of them, you know, deserve a big pat on the back because they also – they really made it happen.

[00:27:21] You know, they did all the work for it.

[00:27:22] So, yeah, full credit.

[00:27:26] Overlooked is written and produced by me, Golda Arthur.

[00:27:30] Jessica Martinez-Dios is our rock star producer.

[00:27:34] We're building a community around women's health so that no one is overlooked.

[00:27:38] If you'd like to be part of it, sign up for the newsletter at overlookedpod.com.

[00:27:44] Get in touch with us by emailing hello at overlookedpod.com.

[00:27:48] Thanks for listening.