Future optimisation of cervical screening

Extending screening intervals

The UK National Screening Committee (UK NSC) has recommended the extension of the screening intervals from three to five years for individuals aged 25 to 49 who test HPV negative as part of their routine screen test. 

Following this recommendation, Scotland and Wales extended their screening intervals and we are expecting other nations to change theirs too in the future. To ensure public acceptability of an increased screening interval, it’s important to provide people with information about the rationale for any change¹

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For further information, read our article explaining why Wales have extended their screening intervals. 

Self-sampling 

Self-sampling means people can take their own vaginal swab (without a speculum) or urine sample, which can be done at home or in a clinic. It is not a routine part of the cervical screening programmes in the UK currently.  

Studies suggest that self-sampling could support non-attenders to participate in cervical screening²

³⁴.  Research to understand the accuracy of self-sampling tests suggest similar sensitivity for HPV between clinician-collected and self-collected samples⁵⁶⁷. 

However, more research is needed to better understand the feasibility of introducing self-sampling into cervical screening programmes, including clinical and cost effectiveness, as well as any impact on inequalities.  

There are some key studies that have been completed or are ongoing: 

YouScreen 

The YouScreen trial⁴

offered self-sampling kits to cervical screening non-attenders in parts of North East and North Central London. The aim was to assess whether self-sampling can improve cervical screening coverage in England and increase detection and treatment of cervical cancer. There was an improvement in coverage seen across demographics.  

82.6% of those who completed a kit and responded to a survey reported high confidence in self-sampling, and 79.9% of responders had high trust in the results. Most (71.3%) would opt for self-sampling in the future, and this was most often preferred by ethnic minority groups, those who were overdue for screening, and those who had never attended cervical screening. However, there were some reports of difficulties using the device, pain and discomfort⁵

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HPValidate  

People were invited for self-sampling when attending their GP practice for cervical screening or when referred to colposcopy at various sites across England as part of the HPValidate trial. The study investigated the effectiveness of self-sampling by comparing self-taken samples with samples taken by a doctor or a nurse. Results are expected to be published soon. 

Papillomavirus Dumfries and Galloway study (PaVDaG)  

In NHS Dumfries and Gallow, vaginal self-sampling kits were sent to screening participants aged 25-64 years of age who have either never attended cervical screening or have not attended their most recent appointment. Initial results found high sensitivity for cervical cancer in self-collected samples, although it was slightly lower compared to clinician-taken samples⁷

. Longitudinal outcomes of the trial suggested that the three to five year recall interval based on clinician-taken samples may also be safe for self-samples⁸.

Alternative CErvical Screening (ACES)  

Urine-based cervical screening could also improve uptake in current non-attenders by eliminating barriers such as access, fear and embarrassment. It could also reduce costs. The ACES Colposcopy study aimed to compare the sensitivity of urine and cervical samples for high-grade (CIN2+) detection in a colposcopy setting using two urine collection devices. Urine collected using a first void urine-collection device had promising sensitivity for CIN2+ detection compared with clinician obtained cervical samples, and urine-based self-sampling was mostly acceptable to patients in this population. Ongoing studies will assess the clinical performance of urine self-sampling in a general screening population, where interventions to improve uptake are necessary, with a particular focus on lesbian, bisexual and transgender male communities⁹

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Papcup 

Papcup is an early-stage innovation that tests for high-risk HPV strains in menstrual blood. The test can be taken at home, with a full test report generated within 15 minutes. This research is at a very early stage, and there is still a long way to go with test refinement and progression to clinical trials.  Find out more in our Cancer News article. 

Automatic invitations for trans men and non-binary people with a cervix 

The call and recall systems used in cervical screening programmes invite people based on their gender as recorded in their primary healthcare record.  GP practices should manage cervical screening administration for eligible people with a cervix registered as male or “indeterminate” with their GP practice who want to opt into screening.  

In Scotland, anyone who is eligible for screening and has changed their gender in their primary healthcare record since June 2015 should receive automatic invitations to cervical screening. People who changed their gender in their primary healthcare record prior to June 2015 will not receive automatic invitations to screening. 

In England, the NHS Cervical Screening Management System manages invitations to cervical screening. In the future, this new system will enable trans men and eligible non-binary people to opt in to cervical screening.  

Unless automatic invitations are available for all eligible people, GP practices have a key role in ensuring these groups can be invited to cervical screening. 

Wider interventions which could optimise cervical screening 

• Targeted education, information and awareness raising initiatives, with a particular focus on underscreened populations, may improve participation¹⁰

  Descamps P. et al. Turning the tide—Recommendations to increase cervical cancer screening among women who are underscreened. Int J Gynecol Obstet. 2024. 

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• Support workers have been found to be effective in improving cervical screening uptake across different socioeconomic and ethnic groups, with successful interventions delivered in person at clinical or community settings. See What works? Key recommendations in this HEEC leaflet  

• Work with faith or community leaders in order to reach underscreened groups and educate them about the reasons for screening. 

• Ensure screening is offered in convenient places/settings and at convenient times, ensuring the consultation room is as comfortable as possible. 

• Health systems could work with local workplaces to share cancer screening information and ensure employers can support employee participation¹¹

  Mon, H.M., Robb, K.A. & Demou, E. Effectiveness of workplace cancer screening interventions: a systematic review. BMC Cancer, 2024. 

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• Use HPV vaccination as an opportunity to educate young people about cervical cancer prevention and the need for screening.

Read more about cervical screening