Common questions from patients

 

This information is for primary care staff, including sample takers and reception staff. Other healthcare professionals may also find it useful.

Your patients may have lots of questions about cervical screening. These are some of the most common ones we hear, along with some simple suggestions of ways to answer them. 

Why are screening tests only every 3 to 5 years?

In most people, the immune system clears HPV within 2 years. If that doesn’t happen, it may go on to cause cervical cell changes. Even at this stage, many cell changes will resolve without treatment. So screening more frequently isn’t necessary and may lead to treatment that isn’t needed. The intervals between screening appointments are designed to strike a balance between detecting HPV and cervical cell changes at an early stage and avoiding over-treatment. 

Why aren’t under-25s screened?

Some patients under 25 may worry that they aren’t offered cervical screening, particularly if there is a big story in the media or they have heard of and are worried about HPV. You can reassure them the decision to start cervical screening at 25 is evidence-based. 

We know that the younger someone is, the more likely it is they will clear HPV without any problems developing. There is also no evidence that screening women aged 22 to 24 reduced the incidence of cervical cancer at ages 25 to 29, and cervical screening in women aged 20 to 24 has little or no impact on rates of invasive cervical cancer up to age 30.

We have patient-facing information about this question > 

Can screening be done during pregnancy?

If a patient is pregnant and due to have cervical screening, they will usually be advised to wait for 12 weeks after giving birth. This is because it can be more difficult to get clear results during pregnancy, not because it’s harmful.

If a patient had an abnormal result before becoming pregnant, they may be advised to have cervical screening at an antenatal appointment. Getting an abnormal result during pregnancy, or being in follow-up and becoming pregnant, can be really worrying. But just as with anyone else, an HPV result can be followed up a year later. And, if a colposcopy is needed, that can be done safely during pregnancy.  

When in the menstrual cycle should cervical screening take place?

Sample taker guidance recommends that cervical screening should be avoided during a patient’s period, because the blood can make it more difficult to get an adequate sample. But it can happen at any other point in the menstrual cycle. If a patient does not have periods for any reason, they can have screening at any time.  

Why do people who have had the HPV vaccine need to be screened?

Although being vaccinated against HPV reduces the risk of cervical cancer, it doesn’t remove it completely. 

The vaccine given on the NHS (Gardasil) protects against high-risk HPV types 16 and 18, which are linked with 7 in 10 (70%) cervical cancers. However, there are some other high-risk types of HPV not covered by the vaccine. So those who have been vaccinated should still be invited and think about attending cervical screening. 

We have patient-facing information about the HPV vaccine > 

Should someone be offered cervical screening if they have symptoms?

No. Cervical screening is a way of preventing cervical cancer. If a patient already has symptoms that may be caused by cancer, such as abnormal vaginal bleeding, they should be offered a pelvic and speculum examination. This should be followed up with other appropriate tests. 

We have patient-facing information about symptoms > 

Why are those over age 64 no longer screened routinely?

Cervical screening prevents cervical cancer by finding cervical cell changes before they have a chance to turn cancerous. Cervical cancer usually develops very slowly – in fact, it is estimated that it takes between 5 and 20 years for HPV infection to develop into cervical cell changes, and then on into cervical cancer. As cervical cancer develops so slowly, it is highly unlikely that patients over 64 who have been regularly screened will go on to develop it.

If a patient’s final 3 screening tests (in the 15 years before turning 65) have been clear, then there is no need to continue cervical screening. If a patient has had an abnormal result in that time, they should continue to be invited until:

• they either have 3 cytology tests showing no abnormal cells
• they have a clear (negative) HPV test.

If a patient over 64 has never had cervical screening, or hasn’t had screening since they were 50, then they are entitled to be screened.

We have patient-facing information on this topic > 

Are trans men invited for screening?

Eligible trans men and/or non-binary people with a cervix are entitled to cervical screening. However, they will only be automatically invited via call and recall if they are registered as female  with their GP surgery. Anyone who isn’t registered as female will need to book an appointment themselves.

Read about supporting trans men and/or non-binary people with cervical screening >

Does someone who’s had a hysterectomy need to go for cervical screening?

No, not if they have had a radical hysterectomy, which removes the cervix. If someone’s had a partial (sub-total) hysterectomy, they should still be invited for cervical screening.  

Does someone who’s had pelvic radiotherapy need to go for cervical screening?

No, if someone has had pelvic radiotherapy, including brachytherapy, they should not be invited for cervical screening. This is because, even if they have a cervix, the cells will be too damaged to test properly.