A comparison of the carbon footprint of alternative sampling approaches for cervical screening in the UK: A descriptive study

Abstract

Objective: To understand whether self-sampling can reduce carbon emissions (CO₂ e) from the NHS cervical screening programme (NHSCSP) by comparing the carbon footprint of three sampling strategies: routine cervical sampling, vaginal self-sampling and first-void (FV) urine collection.

Design: Descriptive study.

Setting: National Health Service (NHS), United Kingdom (UK).

Population or sample: Patients aged 25-64 years eligible for cervical screening in the UK.

Methods: A carbon footprint analysis was undertaken for three cervical screening sampling approaches, from point of invitation to screening through to preparation for transport to the laboratory for HPV testing. A combination of primary and secondary data were used, with a bottom-up approach applied to collection of primary data.

Main outcome measures: We report CO₂ e per sampling approach, which is the unit used to express carbon footprint and harmonise the contributions of greenhouse gases with different global warming potentials.

Results: The total carbon footprint of routine cervical sampling is 3670 g CO₂ e. By comparison, vaginal self-sampling had a total carbon footprint of 423 g CO₂ e, and FV urine sampling 570 g CO₂ e. The largest share of emissions for routine sampling was attributable to the carbon footprint associated with an appointment in a primary care setting, which totalled 2768 g CO₂ e.

Conclusions: Routine cervical sampling is up to 8.7-fold more carbon-intensive than self-sampling approaches with equivalent effectiveness. We found negligible differences in the carbon footprint of alternative self-sampling methods, supporting the need for an informed choice of screening options for participants, which includes sharing information on their environmental impacts.

Keywords: carbon footprint; cervical screening; screening uptake; self-sampling; sustainable healthcare.