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You might have seen a story in the news today about how often women and people with a cervix are invited for cervical screening. This blog takes you behind the headlines to clear up what it’s all about and what it means for you.
A study by King’s College London and published today in the British Medical Journal followed 1.3 million women in England between 2013 and 2019. The research compared the number who developed high grade cell changes and cervical cancer (CIN3+) with two different ways of testing cervical screening samples: cytology (looking at cervical cells through a microscope) and HPV primary screening (looking first for HPV, and if present cell changes). They also looked at how changing the way samples are tested might affect how often invitations need to be sent.
One of the main findings was among those aged 24-49. The number diagnosed with CIN3+ was 74% lower for those who had had their samples tested with HPV primary screening and no HPV found, compared to after a negative cytology result. This is hugely positive, and reinforces previous research which shows HPV primary screening is a far more sensitive and effective test that picks up those at risk of cervical cancer much earlier than testing through cytology. HPV primary screening has been used in Wales since 2018, England since 2019 and Scotland since 2020. The researchers also say that as a result of the more effective HPV primary screening, inviting women under 50, who test negative for HPV, every 5 years is safe. This supports recent changes in Scotland and Wales, which are imminent across the rest of the UK, to invite those who test negative for HPV in five years time.
Right now, nothing has changed! This study is just providing more evidence around the safety of ongoing changes to the cervical screening programmes. The findings provide reassurance that most women and people with a cervix can safely be screened less often and that those who need monitoring more frequently are identified more effectively and earlier.
In 2016 the UK National Screening Committee – who make recommendations on screening - recommended changing cervical screening from cytology to HPV primary screening. Northern Ireland is the only country yet to make this change. The Committee also said that as a result of this more sensitive test, it is safe to invite everyone who tests negative for HPV every 5 years.
Wales and Scotland have already moved to 5 year testing for everyone who tests negative for HPV on their previous test. England and Northern Ireland have not said when they will move yet.
Almost all cervical cancers are linked to high-risk HPV. By knowing who has high-risk HPV, we can make sure that we monitor the virus in case it causes any cell changes. 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.
Your immune system will normally clear an HPV infection on its own and often within two years. If your body does not clear the HPV, it can cause cells in the cervix to change but this is a very slow process. It usually takes 10 to 15 years or more for HPV to develop into cervical cancer. If you do not have HPV, it is safe for your next cervical screening to be in 5 years, because of the time it takes for HPV to cause cells to change. It also gives your body time to clear HPV infections on its own.
If screening shows you have high-risk HPV, the same sample will be tested for cell changes.
This is extremely rare. Scientists have known since the 1990s that nearly all cervical cancers are caused by HPV. There may be some very rare types of cervical cancers that develop without HPV. There can also be problems with some types of testing in the past that missed the HPV.
Even though this is extremely rare, it’s important to be aware of any symptoms and changes and to contact your GP if you are worried.
Before 2019 in the UK HPV testing was not widely used. It’s likely that some women were diagnosed with cervical cancer, but they did not know that this was caused by HPV.
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.
Categories: cervical screening