Cervical screening

Also called Cervical cancer, Smear test, HPV

One of the few cancers we could largely eliminate. Screening plus the HPV vaccine is how, and uptake is falling.

What it is

Around 3,200 people are diagnosed with cervical cancer in the UK each year, and around 850 die.

Almost all cervical cancer is caused by persistent infection with high-risk HPV, a very common virus. That single fact is why this cancer is preventable in a way almost no other is.

Two things prevent it. The HPV vaccine, given in school year 8, which has already produced dramatic falls in pre-cancerous changes in vaccinated cohorts. And screening, which now tests for HPV first and looks at cells only if HPV is found, making it more sensitive than the old smear.

NHS screening covers ages 25 to 64. Uptake has fallen to around 68% in England, which is well below target, and the reasons are worth taking seriously.

Signs you might notice

Screening exists because early changes cause no symptoms at all.

Later: bleeding between periods, after sex, or after the menopause.

Unusual vaginal discharge.

Pain during sex, or pelvic pain.

Any bleeding after the menopause needs urgent assessment regardless of screening history.

How it can affect day-to-day life

The barriers to screening are practical and emotional, and dismissing them does not improve uptake. Embarrassment, previous painful experiences, sexual trauma, disability access, body size, trans and non-binary people being invited badly or not at all, and simply not being able to get an appointment.

Every one of those has a workaround. Nurses can use a smaller speculum, allow self-insertion, book a double appointment, or arrange a chaperone. Almost nobody is told this.

People with a learning disability have markedly lower uptake, and reasonable adjustments are a legal requirement.

HPV positivity causes anxiety and shame that is misplaced: it is extremely common, usually cleared by the immune system, and says nothing about anybody's behaviour.

Supporting someone well

Book the appointment, and if the test has been difficult before, say so when booking. Ask for a longer appointment, a smaller speculum, or to insert it yourself.

Support people with additional needs to attend, including a desensitisation visit first where useful.

Explain HPV honestly: common, usually transient, not a reflection on anybody.

Take up the vaccine, and note that it is now offered to boys as well, because HPV causes other cancers too.

Investigate post-menopausal bleeding urgently, whatever the last screening result was.

If you have been treated for cell changes, keep the follow-up appointments.

Where to get help

Book through your GP practice, and some areas offer clinics in the evening and at weekends.

Jo's Cervical Cancer Trust run a free helpline on 0808 802 8000 and support people who find screening difficult.

Postal HPV self-sampling is being rolled out for people who do not attend; ask whether it is available.