HPV primary screening

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Human papillomavirus (HPV) primary screening, which is sometimes known as primary HPV testing, is a new way of examining cervical screening (smear test) samples. This method was trialled at six test sites in England by the NHS England Cervical Screening Programme. The trial was successful and in July 2016 it was announced that HPV primary screening will be being rolled out across the whole of England in 2019 [1]. In January of 2016, the Welsh Government announced that they NHS will also be moving to HPV primary screening [2]. This will start from April 2017, an will begin with a trial or ‘pilot’ programme that will cover around 20% of the women in Wales. After this, the full roll-out is expected to start in 2018/2019.

Other than HPV primary screening, the NHS Cervical Screening Programme currently tests for high-risk HPV for two different reasons:

  • HPV triage – to help decide if treatment is needed for borderline or low-grade cell changes (dyskaryosis)
  • Test of cure – to see if the treatment of abnormal cells has been effective [3].

You can find out more about these HPV testing techniques and where in the UK they are used on our HPV testing page.

In both HPV triage and test of cure the sample of cells that was collected during your cervical screening appointment is tested for high-risk HPV after it has been examined under a microscope (cytology). With HPV primary screening the sample of cells is tested for high-risk HPV first. Cervical screening (smear) appointments will happen in exactly the same way they currently do all that will change is how the sample of cells is examined once it is sent off to the lab.

If high-risk HPV is not found, which would give a negative HPV test result, then you are safe to return to the normal screening programme. This is because without having a high-risk HPV infection there is virtually no chance of a woman going on to develop cervical cancer before her next test is due.

If high-risk HPV is found (HPV positive result) then cytology will be done to confirm if cell changes are present. If abnormal cells are seen under the microscope (abnormal cytology) you will be referred to colposcopy. If there are no abnormal cells (normal cytology) you will be screened again in 12 months. In this rescreening your cells will again be tested for high-risk HPV first before cytology. Around four out of every ten people (40%) affected by a high-risk HPV infection will clear it within 12 months and this increases to six out of every ten people (60%) within two years [4]. This is why it is better to wait for 12 months and rescreen women who are positive for high-risk HPV but negative for abnormalities, because they may well clear the infection during this time without any abnormal cells developing, meaning no treatment will be needed.

The figure below outlines how the full process of HPV primary screening works [5].

If you are a health care professional involved in smear taking, please visit our Information for Practice Nurses and GPs pages where you will find a wide range of content, best practice guidelines, relevant links for you and your patients, and resources and ways that we can support you. You can also sign up for our quarterly health care professional e-newsletter.

 

References

  1. BBC, 2016. HPV primary screening in the cervical screening programme. www.bbc.co.uk/news/health-36701516. Accessed: 12.01.2017.
  2. Welsh Government, 2017. Improved cervical & bowel cancer screening tests to be introduced. http://gov.wales/newsroom/health-and-social-services/2017/170111screening/?lang=en. Accessed: 12.01.2017.
  3. Public Health England, 2015. Cervical screening: programme overview. www.gov.uk/guidance/cervical-screening-programme-overview. Accessed: 06.07.2016.
  4. Kitchener HC et al, 2009. ARTISTIC: a randomised trial of human papillomavirus (HPV) testing in primary cervical screening. Health Technology Assessment 13(51).
  5. Public Health England; NHS Cancer Screening Programmes, 2015. HPV Primary Screening Protocol Algorithm. www.gov.uk/government/uploads/system/uploads/attachment_data/file/437976/hpvps-flowchart-jan15.pdf. Accessed: 06.07.2016.
Date last updated: 
16 Jan 2017
Date due for review: 
08 Jul 2018

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