Behind the headlines: Cervical screening in Wales

This week, the Cervical Screening Programme in Wales announced that it is changing. Lots of you got in touch with concerns and questions, so we’re taking you behind the headlines to help you understand what the announcement means for you. 

As of the 1st of January the routine screening interval for women and other people with a cervix in Wales aged 25 - 49 has moved from three to five years. 

Why has this happened?

Cervical screening across most of the UK has changed over the past few years. This is part of ongoing improvements to the programme. In England, Scotland, and Wales, HPV primary screening is now used as the testing method on samples collected at cervical screening. 

What is HPV primary screening? 

Almost all cervical cancers are linked to high-risk HPV. High-risk HPV can cause the cells in your cervix to change. These cells can develop into cervical cancer over time. Samples taken at cervical screening are first tested for high-risk human papillomavirus (HPV). If you have high-risk HPV, your sample will be tested for cell changes.

By knowing who has high-risk HPV, we can make sure that we monitor the virus in case it causes any cell changes. Many HPV infections are cleared by the immune system without doing the body any harm. If you do not have it, risk of developing cervical cancer is extremely low. HPV primary screening is a more accurate test than the previous method (cytology). This means it is better at detecting cell changes overall, as well as detecting them earlier.

Read more about HPV primary screening > 

Why have Wales changed how often they send invitations?

As HPV primary screening is more sensitive and accurate, meaning changes are picked up earlier, evidence shows it is safe for those who test negative for high risk HPV to be screened less often. This is partly because any infection is picked up earlier. It also means that when you are invited is now more closely linked to your individual risk of developing cervical cancer, as if you test positive for high-risk HPV you will be monitored more often. 

When will I be invited? 

In the UK, you are automatically invited for cervical screening if you are:

• between the ages of 25 to 64
• registered as female with a GP surgery.

You may get your first invite up to 6 months before you turn 25. You can book an appointment as soon as you get the invite.

The next invite depends on your results of your last test. Without having high-risk HPV, it is very unlikely that your cells will change.

• If you have HPV and cervical cell changes, you will be invited for a further check at colposcopy.
• If you have HPV but no cervical cell changes, you will be invited back in one year. 
• If you do not have HPV, you will now be invited back in five years, because your risk of cervical cancer is very low, even if you have cervical cell changes. If you do not have HPV, the risk of these developing into cervical cancer is very low and they are likely to go back to normal on their own.

Is this just in Wales?

Each country is implementing these changes (HPV primary screening and moving to 5 year intervals) at their own speed. Scotland extended the screening interval to 5 years at the same as implementing HPV primary screening in March 2020. 

Other countries like Australia and the Netherlands also invite you every 5 years if you are high-risk HPV negative.

Is it safe?

The UK National Screening Committee is a body of scientists who advise ministers and the NHS about screening programmes. They make recommendations to the Cervical Screening Programmes of each country in the UK and have said that it is safe to invite those who test negative for high-risk HPV every 5 years. This is after reviewing the available evidence and conducting a public consultation. Recommendations are based on science and evidence and there is a body of evidence supporting the move. Screening programmes are designed to maximise the benefits they bring, while avoiding unnecessary tests and the risk of overtreatment. The NHS also does not have infinite resources and so decisions factor in risks, harm, benefits and resources required for different scenarios. 

Most HPV infections are cleared by the immune system and it is important to give the body time to do this. Sometimes HPV can make cells change, but this happens slowly, over many years. If cells in the cervix develop between tests, they can be picked up at the next test. Cervical cancer is a slow growing cancer and takes many years to develop. Cervical screening programmes work to maximise the benefits of screening and avoid risks associated with unnecessary tests and treatment.  There are many who find screening and gynaecological examinations difficult.

Throughout the UK, around 1 in 3 do not attend cervical screening when they are invited and we must focus on ensuring more women and people with a cervix understand the importance and benefits of cervical screening, and are supported to attend. It is really important that changes about cervical screening are communicated clearly so that the benefits, and what changes mean, are understood.

I have questions

Our support services are here for you if you have further questions about any aspect of cervical screening. You can call our Helpline on 0808 802 8000 or email us >

There is further information on Public Health Wales’ website: https://phw.nhs.wales/services-and-teams/cervical-screening-wales/change...