What is cervical screening?
Cervical screening is a way of preventing cervical cancer. It is not a test for cancer. It tests for a virus called human papillomavirus (HPV).
High risk HPV can cause cell changes in the
, which may develop into cancer over time. But not all cell changes will develop into cancer. So it's important to monitor any changes and give treatment if necessary. Nearly all cases of cervical cancer are linked to high risk HPV.
Cervical screening uses HPV primary screening. During the test, a nurse or doctor uses a small soft brush to take a sample of cells from the cervix. They send this sample to the laboratory. The cervical cells are first of all tested for the HPV virus. If high risk HPV is found, the laboratory will test the sample for cell changes.
You might also hear this test called a smear test. This was the test used before HPV testing.
Who can have cervical screening?
Cervical screening is free for anyone with a cervix from age 25 to 64. This includes women and some trans men and non-binary people assigned female at birth.
You need to be registered with a GP to get your screening invitations. And you need to be registered as female. You get an invite every 3 to 5 years depending on where you live and your age.
You may get your first invitation for screening in the 6 months before you turn 25. If this happens you can book an appointment. You don’t have to wait for your 25th birthday.
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 age 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 request this. You can do this via your GP or a clinic that provides cervical screening.
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. HPV primary screening is more accurate than the previous smear test. It is better at picking up who is at a higher risk of developing cervical cancer. This means the intervals for those not at high risk can be safely extended from 3 to 5 years.
Scotland and Wales were the first to change to the new interval of 5 years. It is likely that this will change in England soon.
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 found that screening younger women leads to more harm than benefit.
Women are not routinely invited for cervical screening above the age of 64 years. It is unlikely that you will develop cervical cancer at this age if you have had regular screening and do not have HPV.
If you are aged 65 or over and have never had cervical screening, you can request a test if you want one.
Your doctor may recommend you continue with screening at this age if you have:
- recently tested positive for HPV
- had a recent result of abnormal cervical cell changes
Your healthcare team can explain how long you have appointments for.
If you would like to receive invitations for cervical screening you need to be registered with a GP. Having a GP also means you can access other healthcare when you need it. You can search for a GP on your NHS website (for England, Scotland or Wales) or the Northern Ireland Health and Social Care website.
If you are not registered with a GP, you can still request cervical screening if you are eligible. You will need to remember when your next screening appointment is due. If this is overdue, you can still book an appointment. Don’t wait another 3 or 5 years. You can book an appointment at:
- your local contraceptive or sexual health clinic
- other specialist clinics that offer cervical screening
Possible benefits and risks of cervical screening
You can choose whether you go for cervical screening or not. Knowing the benefits and risks can help you decide.
For a screening programme to be useful, the tests need to:
- be reliable at picking up abnormalities that could lead to cancer, or picking up cancers
- 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.
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. This is because it is impossible to know if they will 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).
Do I need to have cervical screening if I’ve had the HPV vaccination?
Yes, you should still consider taking part in cervical screening if you’ve had the HPV vaccine. Cervical screening can reduce your risk of developing cervical cancer.
Girls and boys are offered the vaccine at the age of 12 and 13. This is to protect against cancers caused by HPV, including cervical cancer. The vaccine works best in young people before they are likely to come into contact with the virus. The HPV vaccine also protects against some mouth and throat cancers and cancer of the anus and genital area. It also prevents some genital warts.
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 ages 12 to 13.
The vaccine protects against the 2 types of HPV that cause most cases of cervical cancer. But it doesn't protect against other types of HPV that are linked with cervical cancer. This means that women who have had the HPV vaccine still need cervical screening from age 25.
Do I need cervical screening if I haven’t had sex?
HPV is passed from one person to another through close skin-to-skin contact. You are at risk of getting HPV with any kind of sexual contact including:
- oral sex
- touching in the genital area
- vaginal sex
- anal sex
- sharing sex toys
It is possible to get HPV from just one occasion of sexual contact. You may have HPV as a result of sex that you had a long time ago. While most people’s immune system gets rid of HPV, it can be a persistent virus in some.
If you have not had any kind of sexual contact your risk of getting HPV is low. And your risk of developing cervical cancer due to abnormal changes in the cervix is low. Almost all cases of cervical cancer are linked to high risk HPV. You may decide not to have screening if you have not been sexually active. But you can go for screening if you want to. It might help to talk it through with your GP, or a doctor or nurse at a screening clinic.
Should I have cervical screening if I’m pregnant?
If you are pregnant, your routine cervical screening can usually be delayed until after you have had your baby. But this depends on your situation, so do check this with your GP.
Do I need cervical screening if I’ve had a hysterectomy?
Whether you need screening or further tests depends on:
- the type of hysterectomy you’ve had
- the reasons for your operation
- the results of any tissue samples (
biopsies ) taken during your operation
A hysterectomy is an operation to remove some of the female reproductive organs. There are different types of hysterectomy.
Total or simple hysterectomy to remove abnormal cervical cells or cancer
A total or simple hysterectomy is an operation to remove the womb and cervix. If you had this operation to remove cancer or abnormal cervical cells, you may need to have a follow up test on the cells at the top of your vagina. This tests for HPV and is called a vaginal vault test, or a vault sample (smear). Your healthcare team can tell you more about this and when you need it.
Total or simple hysterectomy for other reasons
As your cervix has been removed, you don’t need cervical screening. But you may need to have a vaginal vault test in some situations. For example:
- if biopsy results show that you had abnormal cells or cancer
- if you did not have regular cervical screening before your operation
Check what follow up appointments you need with your healthcare team.
The screening programme won’t necessarily know about your operation. So you may still get an invitation accidentally when you don’t need one.
Sub-total hysterectomy
A sub-total hysterectomy is surgery that removes the womb but leaves the cervix in place. You still have a cervix and so you should consider cervical screening when invited.
Ask your GP or healthcare team if you’re not sure whether your cervix was removed as part of your hysterectomy.
Preparing for your cervical screening appointment
You can book an appointment at your GP practice, sexual health clinic or a specialist clinic. It can help if you know what to expect during the test.
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 after sex, between periods or after the menopause
-
vaginal discharge that smells unpleasant
-
pain during sex
See your doctor if you notice anything unusual. Many conditions can cause these symptoms. Most of them are much more common than cervical cancer. But it is important to get your symptoms checked out.
