What is HPV primary screening?

England, Wales and Scotland are using HPV primary screening. HPV primary screening looks at the cells taken during a smear test and tests them for the HPV virus. The laboratory will look to see if you have high risk HPV.

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 and further tests. If there are no cell changes you will be invited back for cervical screening in 1 year.

About cervical screening

Q: 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.

Screening means testing people for early stages of a disease before they have any symptoms.

Cervical screening is still going ahead in the UK. But because of COVID-19, there are delays. You might have to wait longer for your screening test or a follow-up appointment. There might also be changes to what happens at your appointment to keep you safe. This includes the staff following strict guidance on infection control to protect you and themselves. This means that you won’t be able to take someone with you to your appointment. Your results might be delayed, so ask at your appointment how long it might take and who to contact if you haven’t heard in that time. It’s important to remember that screening is for healthy people with no symptoms. If you notice any unusual changes to your body that don’t go away, talk to your doctor. In most cases it won’t be cancer, but it’s best to get it checked out.

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 human papilloma virus (HPV). High risk HPV can cause cervical cells to become abnormal. Virtually all 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. If high risk HPV is found, the laboratory will test your sample for cell changes.

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.

Who can have cervical screening?

The NHS cervical screening programme invites women from age 25 to 64 for cervical screening. Depending on where you live and your age, you get an invite every 3 to 5 years. You need to be registered with a GP to get your screening invitations.

For England and Northern Ireland – 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.

For Wales and Scotland – you get an invite every 5 years if you are aged 25 to 64.

If you are over 65 and have never had cervical screening, you can ask your GP for a test if you want one.

Cervical screening is also for anyone within this age range who has a cervix, such as trans men and non-binary people. You can talk to your GP about this.

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.

Why are there differences between the UK nations?

The UK National Screening Committee advises the NHS about the different screening programmes, including the cervical screening programme.

They recommend that all people with a cervix aged 25 to 64 are invited for cervical screening every 5 years. This has changed from 3 to 5 years because the test used in cervical screening has changed. The new test is known as HPV primary screening and is more accurate at detecting who is at higher risk of developing cervical cancer. This means the intervals for those who are not at high risk can be safely extended from 3 to 5 years.

Scotland and Wales were the first to implement the new intervals and we expect that this will be implemented in other parts of the UK soon. Northern Ireland doesn’t use HPV primary screening yet, but we hope this will change soon.

How you have the cervical screening test

You can book to have your cervical screening appointment at:

your GP practice
some sexual health clinics
specialist clinics for cervical screening

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. 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.

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Transcript

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

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.

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 wellbeing 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 also provide cervical screening services.

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 female staff are trained to work with women who have experienced sexual violence.

Screening results

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 and where they live.

What happens if I test positive for HPV?

The laboratory will also 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 earlier than normal. This is usually after 1 year.

What happens if I test negative for HPV?

Your sample will not be tested for cell changes. Cell changes or cervical cancer are unlikely to develop without HPV. So you will be invited back for cervical screening in 3 or 5 years time, depending on your age and where you live.

Possible benefits and risks of cervical screening

Possible benefits

Cervical screening helps prevent cervical cancer from developing and saves thousands of lives every year in the UK.

Risks

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 see your GP if something doesn’t feel right for you. Some people 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 certain types of 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).

HPV vaccination

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.

An English study in 2021 showed that the vaccine dramatically reduced cervical cancer rates by almost 90% in women in their 20s who were offered it at age 12 to 13.

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.