All women aged 25 to 64 in Scotland are invited for cervical screening. Women aged 25 to 49 are invited every three years and women aged 50 to 64 are invited every five years. The test can pick up changes to the cells in the cervix which if left untreated could develop into cervical cancer. Women on non-routine screening (where screening results have shown changes that require further investigation/follow up) will be invited up to the age of 70.
Most changes in the cells are caused by the human papilloma virus (HPV). HPV is a common virus transmitted during sexual contact. The body fights several types of HPV infections naturally but 1 in 10 of these infections (high risk HPV types) is harder to get rid of and without being monitored and treated could develop into abnormal cells that can cause cervical cancer.
A new way of testing will be introduced from early 2020 called HPV testing (also referred to as high risk HPV testing). The HPV test will be carried out using the same samples of cells taken during a cervical screening/smear test so the cervical screening experience for women will remain unchanged. The high risk HPV testing newsletter (July 2018) (external download; 641 KB) details the service change and provides more information.
In 2016 the age range and frequency of cervical screening changed to 3-yearly from age 25 and 5-yearly from age 50 to 64. For more information about this change you can download the 2016 professional briefing. This link will also allow you to download professional resources including a CPD slide set for smear takers and a question and answer paper.
- Cervical cancer is the most common cancer in women aged 25 to 35 years of age in Scotland.
- Around six women in Scotland are diagnosed with cervical cancer every week.
- Cervical screening is the best protection against cervical cancer and saves around 5,000 lives every year in the UK.
- Cervical screening prevents 8 out of 10 cervical cancers from developing.
- Eligible women are sent an invitation letter to their home (with an information leaflet) and asked to make an appointment at their local GP or clinic.
- The most up-to-date figures on annual uptake show that 73% of eligible women were screened.
- Uptake for women aged 25 to 64 in the least deprived areas was 78% compared with 67% in the most deprived areas.
Information Services Division’s Cervical Screening Programme page (external website) has more information on cervical screening.
Cervical screening and health inequalities
A woman’s risk of developing cervical cancer increases if they are or ever have been sexually active, of if they smoke. The risk of cervical cancer increases when a person smokes because tobacco smoke affects the cells in the cervix. Another important risk is missing their cervical screening appointment. Evidence shows lower participation in cervical screening among women in the following groups:
- 25 to 34 year olds
- women living in areas of high deprivation
- women with a learning or physical disability
- black or minority ethnic (BME) women
- lesbian and bisexual women
- those eligible within the transgender community.
Practical barriers can include women unable to make appointment times or lack of transport. Or personal barriers, such as lack of knowledge or awareness of the purpose and benefits of the test, as well as fear and anxiety about the procedure itself, can also play a role in women’s uptake to cervical screening. Women may have never attended cervical screening or they may be overdue their appointment. Some women will also make an informed choice not to attend their cervical screening.
We have produced a toolkit to help GPs, practice nurses and practice staff to optimise uptake, reduce barriers and ensure women are making an informed choice about cervical screening. The toolkit includes a range of best-practice approaches that you could use to add value to existing work or may wish to try to optimise participation in your local area. The toolkit also contains more detailed information about the Scottish Cervical Call-Recall System (SCCRS). The system health professionals use to support the cervical screening programme.
Local and national action
The Scottish Government launched the Detect Cancer Early programme (external website) in 2012. This aims to improve survival for people with cancer by diagnosing and treating the disease at an early stage. The 'Get Checked Early' Scottish Government website has information for the public, including cervical cancer and screening information (external website).
The Scottish Government’s 2016 Scottish Cancer Strategy (PDF, 1.71 MB)(external website) 'Beating Cancer: Ambition and Action' sets out a clear commitment to reduce inequalities in cancer screening.
To support practices to deliver the Scottish Cervical Screening Programme to the highest standard the Scottish Government, NHS Education for Scotland, Healthcare Improvement Scotland and a number of expert clinicians work together to provide quality assured training courses and training standards for smear takers in Scotland.
There are a variety of training and CPD courses available for smear takers. Visit NHS Education for Scotland (NES) for more information.
There are national Standards for Education providers: Cervical Cytology (PDF) for education providers. General practices must ensure that all smear takers are appropriately trained to see the cervix fully when taking a sample. This is essential to ensure that the correct cells are being collected and visible changes in or abnormalities of the cervix are identified as early as possible. You may find this resource useful - Cervix chart for sample smear takers in primary care.
The Clinical Standards for Cervical Screening, published in 2002 by the Clinical Standards Board for Scotland, have been identified for review. Visit the Healthcare Improvement Scotland website for more information.
With every cervical screening appointment letter an information leaflet is sent to enable women to make an informed choice about whether to attend their screening appointment. Leaflets are available in other languages and Easy Read format.
A Smear Test Could Save Your Life provides further information on the screening programme for all those eligible as well as answering frequently asked questions about the test and cervical cancer.
Your Smear Test Results provides information about the results of your smear test, how they will be monitored and any treatment you may need.
Your Smear Test After Treatment provides information about what will happen after your cervical intraepithelial neoplasia (CIN) treatment.
A cervical screening poster encouraging women to take up their smear test invitation is also available.
NHS inform hosts further cervical screening information for the public. This includes a short film explaining the screening process and information available in British Sign Language (BSL) and audio format.