Test for cervical cell changes, regardless of HPV negative results

Commit to testing for cervical cell changes, regardless of the HPV result.

With the latest changes, if you do not have high-risk HPV, your sample will not be looked at for cell changes. This will without a doubt increase cervical cancer deaths and later stage diagnosis.

Myself and a number of other women I know had HPV negative smear tests with cell changes that turned out to be cervical cancer. Had we only been tested for HPV and sent away for 3-5 years, we would not have survived.

The Government recognises your concerns and is committed to the early detection and treatment of cervical cancer. The National Cervical Screening Programme (NCSP) aims to detect abnormalities of the cervix at an early, often asymptomatic stage that, if left undetected and untreated, may develop into cancer. Screening is offered to all eligible women aged 25 to 49 every three years and those aged 50 to 64 every five years. This saves an estimated 5,000 lives a year in England by detecting abnormalities of the cervix early and referring women for effective treatment.

The United Kingdom National Screening Committee (UK NSC), which advises the NHS and the Government on all aspects of screening, constantly reviews scientific research and clinical evidence to ensure that screening programmes are as effective as possible. In November 2015 the UK NSC recommended that screening for high-risk types of human papillomavirus (hrHPV) should replace cytology tests as the primary screening for cervical disease. This evidence review that formed the basis of this recommendation can be viewed in the published evidence summary, available at https://www.gov.uk/government/publications/cervical-screening-primary-hpv-screening-implementation/cervical-screening-implementation-guide-for-primary-hpv-screening#fn:3

HrHPV testing has been shown to reduce the risk of developing cervical cancer through increased sensitivity for underlying disease. The research reviewed included evidence (https://pubmed.ncbi.nlm.nih.gov/24192252/) from four large-scale randomised controlled trials from across Europe that considered the use of hrHPV testing as a primary screening test. It found that HPV-based screening provides 60-70% greater protection against invasive cervical carcinomas compared with cytology-based screening.

The presence of certain types of hrHPV can cause cells in the cervix to change and become abnormal, which can then go on to become cancerous. A cytology test is then used to check for any abnormal cells if hrHPV is detected during cervical screening. If no abnormal cells are found, a follow up screen is arranged for 12 months’ time to see if the immune system has cleared the virus. More information about HPV and cervical cancer can be found here: https://www.nhs.uk/conditions/cervical-cancer/causes/, https://www.gov.uk/guidance/cervical-screening-programme-overview.

Further research (https://www.sciencedirect.com/science/article/pii/S0301211517301409) suggests that at least ten years elapses between acquiring hrHPV and developing cancer. The high negative predictive value of hrHPV testing and lower false negative rate means screening intervals can be lengthened in women who test negative for hrHPV. This means that if the woman tested does not have any evidence of hrHPV infection her chances of developing a cancer within five years are very small. As nearly all (99.7%) cervical cancer is caused by hrHPV, the hrHPV negative result indicates there is no requirement for further tests. It would be highly unlikely that there would be any abnormal cells. Even if there was, it would be extremely unlikely that they would cause any problems.

We acknowledge however that screening is not perfect and will not detect all cases. For cervical screening, this can happen if the HPV infection or abnormal cells are missed (a false negative result, which is unlikely), or because abnormal cells develop and turn into cancer in between screening tests. That is why we recommend that women continue to be screened regularly and speak to their general practitioner if they have any concerns or symptoms.

Screening is only offered where the benefits outweigh the harms. This change to hrHPV-based primary screening was made because it was evidenced to be more beneficial than cytology-based primary screening. The hrHPV-based primary screening has greater efficacy. With the cytology-based primary screening, women are more likely to have to undergo unnecessary tests and treatments for abnormalities that may not develop into cervical cancer and resolve without intervention.

The NHS Long Term Plan (https://www.longtermplan.nhs.uk/areas-of-work/cancer) sets out a comprehensive package of measures that will transform cancer diagnosis and treatment across the country over the next ten years; a decade in which patients can expect to see huge improvements in the prevention, diagnosis and treatment of cancer. The aim is to see 55,000 more people surviving cancer for five years in England each year from 2028, there is no complacency on this matter in government.

Public Health England is also working continuously to raise awareness of cervical cancer through the national ‘Be Clear on Cancer’ campaigns, which have been run in partnership with Cancer Research UK since 2011. A specific awareness campaign, ‘Cervical Screening Saves Lives’, was held in 2019 and is currently being evaluated.

Department of Health and Social Care