What the recent changes to smear tests mean for the future of cervical cancer screening in the North East
HLN’s expert in residence, Dr Charlotte Gooding, explains the recent changes to cervical cancer screening.
By Dr Charlotte Gooding
When Wales announced changes to its Cervical Screening programme at the beginning of this year, there was a lot of confusion and concern across the UK.
And understandably so. On the surface, Cervical Screening Wales’ (CSW) decision to extend the routine screening interval for people with a cervix (aged between 25 and 49) from three to five years seems to be unnecessarily risky – especially when we know that of all the cases of cervical cancer cases in the UK, 99.8% were preventable.
Here, I will try to explain more about some of the changes that have been implemented to cervical cancer screening and why they have been made. It’s important to outline that these changes have been made in response to evidence from trials and reflect the understanding that we now have about the causes of cervical cancer – an understanding that is far greater now than it was when the cervical screening programme was first introduced 50 years ago!
WHY ARE SMEAR TESTS ONLY EVERY 5 YEARS IN SCOTLAND AND WALES NOW?
Back in March 2020, Scotland extended the interval between routine smear tests from three to five years for anyone with a cervix between the ages of 25 and 49, where HPV wasn’t found in their smear test. At the beginning of this year, Wales followed suit.
So, why the change? Well, because the test used in cervical screening has now changed. This new test is known as HPV primary screening, and is more accurate at detecting who is at a higher risk of developing cervical cancer. This means it’s safe to extend the intervals for those who are not at high risk.
It’s expected that this extension will be implemented in other parts of the UK soon.
WHAT IS HPV?
HPV – which stands for Human Papilloma Virus – is a common virus that 8 in 10 people will get. HPV lives on our skin and is usually passed on by any type of sexual contact.
Thanks to advances in modern testing, we can now split HPV into two types:
- High risk HPV
- Low risk HPV
Low risk HPV might not cause any problems, or only mild ones like warts on the hands and feet or genital warts. Most HPV is low risk
High risk HPV can be linked to some cancers. In cervical cancer, the virus causes changes to the cells of the cervix. This process can take many years.
Both low and high risk HPV can be cleared by the body’s own immune system without it causing any problems.
Screening in England, Scotland and Wales now checks for high risk HPV first. There is no treatment for the virus itself, but there are treatments for the conditions caused by it, such as: warts, cervical cell changes and cancer.
HOW CAN I REDUCE MY RISK OF HPV?
Many people feel embarrassed or ashamed of having contracted HPV. However, it’s very easy to be passed on, as it can be difficult to detect that you have it and hard to completely protect against it by simply using barrier contraception methods.
But that’s not to say it’s impossible to reduce your risk of contracting the virus. The following lifestyle changes have been scientifically proven to protect you against contarcting HPV:
Stop smoking – smoking can lower the immune system’s response to HPV, meaning the body is less able to defend itself from infection.
Get the cervical cancer vaccine – the HPV vaccine protects against some types of HPV, including those that are related to cervical cancer and genital warts.
Try to have safer sex – barrier methods of contraception, such as condoms, can help to reduce the risk of spreading HPV, but they cannot completely protect the whole genital area.
WHAT HAPPENS AT MY SMEAR TEST?
The smear test itself will not change, but the way in which the results are communicated to you and the length of time you’ll be expected to wait in between smear tests will.
If you do not have HPV on your smear, the risk of developing cervical cancer is very low and your sample will not be looked at for cell changes. You will be invited back for another screening in three to five years’ time, depending on your age and where in the UK you live.
If HPV is detected, your cells will be examined for any changes. If there are no cell changes, then you will be invited back for cervical screening in one year to make sure the HPV has cleared.
If high risk HPV and cell changes are found, you will be invited to attend further tests at colposcopy. Please remember that not all cell changes develop into cancer – but it is important that they are monitored and treated, if required.
THE FUTURE OF CERVICAL SCREENING
Each country is implementing changes to the screening intervals. Scotland has already extended its screening interval to five years when it implemented its screening for HPV in March 2020.
In future, cervical screening could be done with a simple self-taken swab kit. There is ongoing research looking into whether self-sampling could be offered as part of the national screening programme, and whether this would improve current take-up rates of smear tests across the UK.
- HPV primary screening is a more accurate way of screening who may be at high risk of developing cell changes and, therefore, cervical cancer.
- This is why the interval between routine smear tests (where HPV isn’t found) has been extended from three to five years in Scotland and Wales.
- Almost all cervical cancers are related to high risk HPV.
- By screening for this, we can make sure those people are monitored, find any cell changes early and treat them before they develop into cancer.
- HPV testing has been proven to be a more accurate test than cytology. It’s better at detecting any cell changes, as well as detecting them earlier.
WHAT IF I STILL HAVE QUESTIONS ABOUT CERVICAL SCREENING?
As the saying goes, knowledge is power – so my advice is certainly to arm yourself with as much knowledge about your body as possible.
ABOUT THE AUTHOR
Dr Charlotte Gooding graduated from Newcastle Medical School in 2008, later qualifying as a GP. In her role, she enjoys educating patients and healthcare professionals and has been involved with teaching medical students at Newcastle University.
Her general practice career has given her a good grounding in all areas of medicine, but her main focus of work is in Women’s Health, where she is passionate about empowering women to seek help for their health issues and offering them support to make positive lifestyle choices at all stages of their lives.
As well as her NHS GP work, Dr Gooding is an associate at Menopause Care: a private menopause clinic which has female patients all over the UK. Her role is to offer evidence-based, up-to-date and holistic care based on a woman’s individual needs. She enjoys being able to work as part of a menopause team, helping women on their journey through mid-life and supporting them in transforming their future health.