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Cervical screening policy across the UK

Your cervical screening result will help decide when you are next invited for cervical screening. Depending on your result, age and where you live, you may be asked to:

  • come back for cervical screening in 1 year
  • come back for cervical screening in 3 years
  • come back for cervical screening in 5 years
  • have some more tests at colposcopy.

Key facts

  • A common virus called HPV is the cause of nearly all cervical cancers. It’s extremely rare to have cervical cancer that isn’t caused by HPV
  • Your immune system normally clears HPV infection. Sometimes HPV causes the cells of the cervix to change
  • Cervical cancer takes a long time to develop: usually 10-15 years or more
  • Cervical screening in England, Wales and Scotland uses HPV primary screening. Northern Ireland uses cytology
  • If you live in Scotland or Wales, you will be invited for cervical screening in 5 years, whatever your age. If you live in England or Northern Ireland you are invited every 3 years if you are age 25 to 49 and 5 years if you are age 50 to 64
  • By knowing who has high-risk HPV we can monitor the virus and find cell changes earlier before they potentially develop into cervical cancer
  • If you do not have HPV your chances of developing cancer caused by HPV within 5 years are very small
  • HPV primary screening means it is safe to wait five years for your next screening if you do not have HPV
  • If you do have HPV, your sample will also be checked for cell changes, and you may have further tests or more regular cervical screening

Why do Scotland and Wales invite every 5 years for all ages?

We are using a better test in cervical screening 

Cervical screening is a free health test that helps prevent cervical cancer. Wales, England and Scotland have introduced HPV primary screening as a way of testing samples collected during cervical screening. HPV primary screening first checks for high-risk human papillomavirus (HPV), a virus that causes cervical cancer. 

Read about HPV primary screening >

Human papillomavirus (HPV) is a common virus that 8 in 10 people will get. Your immune system normally clears HPV by itself, and it usually goes away without causing any problems. Some types of HPV are linked to the development of cancer, and nearly all cases of cervical cancer (99.7%) are caused by high-risk HPV.  

HPV primary screening is a better test than the old way of testing that used cytology. This is where cervical cells were checked under a microscope. By knowing who has high-risk HPV, we can make sure that we monitor the virus and find any cell changes early.

If you have high–risk HPV you will be monitored more closely 

If you do not have high-risk HPV your chances of getting cancer within 5 years are very small. And you are at very low risk of developing cervical cancer before your next screening test. Even if you did get HPV within that time, it normally takes at least 10-15 years for HPV to develop into cervical cancer.  

If screening shows you have high-risk HPV, that same sample will be tested for cell changes.  

  • If you have HPV and cervical cell changes (abnormal cells), you will be invited for a further check with a test called colposcopy, an examination to take a closer look at your cervix.
  • If you have HPV but no cervical cell changes, you will be invited back in one year for cervical screening. 

HPV takes a long time to cause cervical cancer

Your immune system will normally clear an HPV infection on its own. Often within two years. If your body does not clear the HPV, it can cause cells in the cervix to change. If they are not treated some of these cells may become cervical cancer. But this is a very slow process, researchers have found that 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.

Changes to cervical screening has already happened in other countries

In 2016 the UK National Screening Committee recommended changing the way cervical screening happened in the UK. They recommended changing from cytology (looking at cervical cells through a microscope) to HPV primary screening and inviting everyone every 5 years if they do not have HPV. In England, Wales and Scotland HPV primary screening is now used. Wales and Scotland have moved to 5-year testing for all eligible women and people with a cervix who test negative for HPV on their previous test. 

Other countries like Australia and the Netherlands also invite you every 5 years if you do not have HPV. Australia made the switch to HPV primary screening and 5-year screening intervals in December 2017. Researchers predict that Australia are set to become the first country in the world to eliminate cervical cancer by 2066.  

Can you develop cervical cancer more quickly?

The development of HPV into cervical cancer is normally a very slow process. When you are next invited for cervical screening depends on the results of your previous test. This means if you are at an increased risk you can be monitored more closely. If your cervical screening result shows you have high-risk HPV, that same sample will be tested for cell changes.  

  • If you have HPV and cervical cell changes, you will be invited for colposcopy, an examination to take a closer look at your cervix.
  • If you have HPV but no cervical cell changes, you will be invited back in one year for cervical screening. 

HPV primary screening is better than the old way of testing that used cytology. This is where cervical cells were checked under a microscope. It is better at detecting cell changes overall, as well as detecting them earlier.

Can you get cervical cancer without having HPV?

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.

Read about the symptoms of cervical cancer >

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.

What are the other benefits of the changes to cervical screening?

The main aim of these changes is to prevent more cervical cancers and save more lives. A bonus is that the changes will reduce treatment for cell changes that would clear on their own. Treatment for cell changes can be difficult and can have side effects. Some people find cervical screening uncomfortable, worrying or hard to fit in with their lives. They feel positive about having screening less often. 

Moving to 5-year testing is not focused on cost-saving. But reducing unnecessary tests and treatment will be cost-effective and efficient for the NHS. Testing less often may help free-up NHS resources for other things. Such as increasing cervical screening attendance. 

What research were changes to the cervical screening programme based on?

Research shows that waiting 5 years after a negative HPV test is safe. Over the last 15 years randomised control trials have been carried out in different countries that show that HPV primary screening is a very accurate way to prevent cervical cancer. It helps identify those at a higher risk at an earlier stage and saves more diagnoses than the previous way of looking at samples. Randomised control trials are the highest level of research evidence.

Researchers have found that there were less cases of cancer when HPV primary screening was used compared to using cytology.Cervical cancer diagnoses were lower 5·5 years after a negative HPV test than 3·5 years after a negative cytology result. Other researchers found that the risk of having abnormal cells in the cervix after 10 years following a negative HPV result was similar to the risk after about 3 years after a negative cytology result. 

More information and support 

If you have general questions about your cervical screening results or are confused about the next steps, we can help:

Call our free Helpline on 0808 802 8000 – check the opening hours >

If you have medical questions about your results, our Ask the Expert service may be able to help. Our experts cannot give advice on your individual situation as they are not your doctor. Use our Ask the Expert service >

Thank you to all the experts who checked the accuracy of this information.

References 

  • Demarco M, Hyun N, Carter-Pokras O, et al. A study of type-specific HPV natural history and implications for contemporary cervical cancer screening programs. EClinicalMedicine. 2020;22:100293. Published 2020 Apr 25. doi:10.1016/j.eclinm.2020.100293
  • Bosch FX, Broker TR, Forman D, et al. Comprehensive control of human papillomavirus infections and related diseases. Vaccine. 2013;31 Suppl 7(Suppl 7):H1-H31. doi:10.1016/j.vaccine.2013.10.003
  • Plummer M, Schiffman M, Castle PE, Maucort-Boulch D, Wheeler CM; ALTS Group. A 2-year prospective study of human papillomavirus persistence among women with a cytological diagnosis of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion. J Infect Dis. 2007 Jun 1;195(11):1582-9. doi: 10.1086/516784. Epub 2007 Apr 16. PMID: 17471427.
  • Vink MA, Bogaards JA, van Kemenade FJ, de Melker HE, Meijer CJ, Berkhof J. Clinical progression of high-grade cervical intraepithelial neoplasia: estimating the time to preclinical cervical cancer from doubly censored national registry data. Am J Epidemiol. 2013 Oct 1;178(7):1161-9. doi: 10.1093/aje/kwt077. Epub 2013 Jul 28. PMID: 23897645.
  • van den Akker-van Marie ME, van Ballegooijen M, Rozendaal L, Meijer CJ, Habbema JD. Extended duration of the detectable stage by adding HPV test in cervical cancer screening. Br J Cancer. 2003 Nov 17;89(10):1830-3. doi: 10.1038/sj.bjc.6601355. PMID: 14612887; PMCID: PMC2394464.
  • Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 1999; 189: 12–19.
  • Brotherton JM, Budd AC, Saville M. Understanding the proportion of cervical cancers attributable to HPV. Med J Aust. 2020 Feb;212(2):63-64.e1. doi: 10.5694/mja2.50477. Epub 2020 Jan 7. PMID: 31909481.
  • Ronco G, Dillner J, Elfström KM, Tunesi S, Snijders PJ, Arbyn M, Kitchener H, Segnan N, Gilham C, Giorgi-Rossi P, Berkhof J, Peto J, Meijer CJ; International HPV screening working group. Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials. Lancet. 2014 Feb 8;383(9916):524-32. doi: 10.1016/S0140-
  • Gilham C, Sargent A, Kitchener H & Peto J. HPV testing compared with routine cytology in cervical screening: long-term follow-up of ARTISTIC RCT. Health Technol Assess 2019;23(28)

 

Date last updated: 
09 Feb 2022
Date due for review: 
09 Feb 2022