Cervical screening and HPV vaccination

The incidence and mortality of cervical cancer in developed countries has more than halved in the last 30 years, thanks to cervical screening (now including primary human papilloma virus (HPV) testing), and the advent of vaccination against HPV. One observational study using data from cancer registries estimated a relative reduction in cervical cancer of 87% for those aged 12-13 who are vaccinated, compared to an unvaccinated cohort. HPV vaccination is done in schools, but those who miss their vaccine in school and seek one later can be vaccinated in primary care up to the age of 25 – those at particularly high risk can be referred to a sexual and reproductive health clinic for vaccination up to the age of 45. 

There is now a real possibility that cervical cancer may be eradicated – the World Health Organization has set a 90/70/90 target for 2030, whereby 90% of girls are fully vaccinated against HPV by the age of 15, 70% of women have had cervical screening by 35 and 90% of women with pre-cancer or cancer are managed appropriately. The NHS has gone further and aims to eliminate cervical cancer by 2040 - as part of this initiative there will be more flexibility to offer vaccines in convenient places such as libraries and leisure centres, with such premises also offering health checks at the same time as the vaccine.

Cervical screening samples in the UK are now initially tested for HPV; only those which are HPV positive are taken forward for cytology. This has allowed the screening interval to be safely lengthened to five years for all HPV negative women in Wales and Scotland. This page will be updated if England and/or Northern Ireland follow suit. An important exception to this is women with HIV, who continue to need annual smears.

This change to HPV screening does mean that some women will get a letter saying that they have a positive HPV test, but negative cytology, and need a repeat smear test in one year. Some of these women will be concerned that they have a sexually transmitted infection and may phone their GP for advice; those wondering what they would say in such a situation might want to look at the Jo’s trust leaflet on HPV. The RCGP eLearning module on cervical screening provides an update on the current screening process, and cervical screening is also discussed in detail in the RCGP eLearning course on early diagnosis of endometrial and cervical cancer.

More information can be found in the following resources: