Screening means testing people for early stages of a disease before they have any symptoms.
For screening to be useful the tests need to:
- be reliable at picking up cancers or abnormalities that could lead to cancer
- do more good than harm to people taking part
- be something that people are willing to do
Screening tests are not perfect and have some risks. The screening programme should also be good value for money for the NHS.
What is cervical screening?
Cervical screening is a way of preventing cancer. It tests for a virus called high risk human papilloma virus (HPV). High risk HPV can cause cervical cells to become abnormal. Most cases of cervical cancer are linked to high risk HPV.
The cervix is part of the female reproductive system. It is the lowest part of the womb and is at the top of the vagina. A nurse takes a sample of cells from the cervix using a small soft brush (smear test) and sends the sample to the laboratory.
HPV primary screening
England, Wales and Scotland are using HPV primary screening. HPV primary screening tests the cervical cells for the HPV virus first. The laboratory will look to see if you have high risk HPV.
In Northern Ireland, they look for changes in the cervical cells first. They then test for HPV if there are cell changes. Northern Ireland will start using HPV primary screening in the future.
High risk HPV can cause cell changes in the cervix, which over time can develop into cancer. Not all cell changes will develop into cancer but it's important to monitor any changes and give treatment if necessary.
What happens if you have high risk HPV?
If you do have high risk HPV, the laboratory will test your sample for cell changes. If there are cell changes you will be invited for a colposcopy to have a closer look at your cervix. If there are no cell changes you will be invited back for cervical screening in 1 year.
What happens if you don't have high risk HPV?
If high risk HPV isn't found, your sample will not be tested for cell changes. Cell changes or cervical cancer are unlikely to develop without high risk HPV. So you will be invited back for cervical screening in 3 or 5 years time, depending on your age.
Who has cervical screening?
The NHS cervical screening programme invites women from age 25 to 64 for cervical screening. You get an invite every 3 years if you are aged 25 to 49. After that, you get an invite every 5 years until the age of 64. You need to be registered with a GP to get your screening invitations.
Cervical screening also applies to other people within this age range who have a cervix, such as trans men. You can talk to your GP about this.
If you are over 65 and have never had cervical screening, you can ask your GP for a test if you want one.
Why younger women don't have screening
Cervical cancer is very rare in women younger than 25. But changes in the cells of the cervix are quite common in this age group. These changes often return to normal and are less likely to develop into cancer. So screening them leads to unnecessary treatment and worry.
Researchers have worked out that screening younger women leads to more harms than benefits.
Specialist clinics for cervical screening
There are specialist clinics available for people who may feel uncomfortable going for cervical screening.
CliniQ are a holistic sexual health and well being service for all trans people, partners and friends. They are a trans-led team, who offer a safe, confidential space for those who may not feel comfortable accessing mainstream services. They provide a cervical screening service.
My Body Back Project is a specialist service that run clinics where women who have experienced sexual assault are able to access cervical screening. All the female staff are trained to work with women who have experienced sexual violence.
How you have the cervical screening test
You can book to have your cervical screening appointment at:
- your GP practice
- some sexual health clinics
It should be on a day when you are not having your period. A female nurse usually does the screening test. Talk to them if you feel at all nervous about having the test. They can help reassure you. The test itself only takes a minute or two.
Your nurse will ask you to take off your clothes from your waist down, including your underwear. You can usually keep on a loose fitting skirt. You lie on your back on a couch. Your nurse can give you a paper towel to cover your hip area.
You generally lie with your knees drawn up and spread apart. If this is difficult for you, you can lie on your side with your knees drawn up.
Your nurse gently slides a plastic instrument called a speculum into your vagina so that they can see the cervix clearly. Having the speculum put in may be a little uncomfortable but shouldn’t hurt. It can be more uncomfortable if you are very tense. So try to relax. Taking some deep breaths can help. Your nurse will help you to relax.
Your nurse uses a soft brush to take some samples of cells from the surface of your cervix. They put the sample into a pot of liquid to send to the laboratory. They take out the speculum and the test is over. You can then get dressed and go home.
This short video shows you what happens at your cervical screening appointment.
Michelle: I was on my way to cervical screening, not exactly something you look forward to.
Sarah: At first I didn’t think I needed to do this.
Mahreen: I was worried it would be really embarrassing but my friend said, “It’s really important. It can prevent cancer.”
Sarah: And my girlfriend said she’d come with me so I thought…
ALL: Let’s do it!
Mahreen: When I got there I was nervous but the nurse was really nice. She does these tests all the time.
Sarah: I had to take my jeans and pants off and lay down on the bed with my knees up and my legs open.
Michelle: The nurse put something called a speculum into my vagina to help her see the cervix and used a small, soft brush to take the sample.
Mahreen: I thought it might hurt but actually it was only a bit uncomfortable.
Nurse: That’s it. All done! Are you OK?
Mahreen: It was all over in a few minutes and then I went back to work . They’ll send me a letter with the results.
Sarah: And if they do find abnormal cells they can be treated to stop cervical cancer from developing in the first place which is definitely worth it. I’m not scared of it now
Mahreen : So, I’ll do it again in three years and won’t even worry about it.
Michelle: If you’re not sure that you need to, just think
ALL: if you’ve got a cervix then cervical screening is for you.
Michelle: It saves lives.
Your nurse will tell you when you are likely to get the results. It usually takes around 2 to 6 weeks. You get a letter in the post with the results. Most women have a normal result and have the next screening test in 3 to 5 years, depending on their age.
Benefits of cervical screening
Cervical screening helps prevent cervical cancer from developing and saves thousands of lives every year in the UK.
Possible harms of cervical screening
Cervical screening works very well but, like any screening test, it isn’t perfect.
In a few cases, tests will seem to find abnormal changes that aren’t really there. This is called a false positive result. It leads to unnecessary worry and also the need for more tests.
There is also a risk that cell changes may be missed. This is called a false negative result. So it is important to go for screening every time you get an invite.
Some women will have treatment for cervical cell changes that would not have caused any harm if they had been left alone. This is called overdiagnosis or overtreatment. Doctors offer treatment to everyone with the more abnormal cells because it is impossible to know if they would go on to develop into cancer or not. They don’t want to take that risk.
For a few women, the treatments for abnormal cells may cause problems such as bleeding afterwards or infection. If you need to have more cervical tissue removed than usual and then in the future become pregnant, there is an increased risk of having the baby early (premature birth).
Since 2008, girls aged 12 and 13 have been offered a vaccination against the human papilloma virus (HPV). This is to protect against cancers caused by HPV, such as cervical cancer. The vaccine works best in young people, before they are likely to have come into contact with the virus. The vaccine is now offered to boys too.
A Scottish study in 2019 has shown a significant drop in the number of women with abnormal cervical cell changes after having routine HPV vaccination.
Although the vaccine protects against the 2 types of HPV that cause most cases of cervical cancer, it doesn't protect against other types of HPV that are linked with cervical cancer. This means that girls who have had the HPV vaccine still need to go for cervical screening from age 25.
If you have symptoms
As well as going for screening when you are invited, you still need to look out for any unusual changes to your body. Check for:
- abnormal bleeding (such as bleeding between periods)
- vaginal discharge that smells unpleasant
- pain during sex
See your doctor if you notice anything unusual. There are many conditions that can cause these symptoms. Most of them are much more common than cervical cancer. But it is important to get your symptoms checked out.