Cervical screening
Cervical screening is offered to anyone with a cervix aged between 25 and 64 years.
The cervical screening test (also known as a smear test) takes a sample of cells from the cervix (neck of the womb) and checks it for human papillomavirus (HPV). HPV is the main cause of cervical cancer.
People 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.
- 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.
- Over 99% of all cervical cancers are caused by HPV.
- HPV is very common and four out of 5 people in Scotland will have it at some point in their lives.
- Together with vaccinating young people against HPV and introducing HPV testing into cervical screening, we hope to eliminate cervical cancer in Scotland.
HPV testing
HPV testing has replaced cervical cytology (looking at the sample of cells under a microscope) as the primary test.
Cytology-based tests will be used if high-risk HPV is found in the sample. A person’s pathway and subsequent follow-up will differ according to the test results.
If no high-risk HPV is found, the person has a very low risk of developing cervical cancer within 5 years, as it takes around 10 to 15 years to develop after an HPV infection. They are therefore invited for their next routine cervical screening appointment in 5 years’ time, regardless of their age.
To support primary care professionals, we have produced CPD slides, a diagram of the cervical screening pathway and FAQs to help you answer questions and deal with concerns people may bring about the changes made to the cervical screening programme in March 2020.
Key facts about HPV testing
- The UK National Screening Committee (UKNSC) recognises that using HPV testing as the primary test in the cervical screening programme is a better way of identifying those at risk of cervical cancer.
- More lives will be saved by determining a person’s risk and ensuring any changes are found and treated earlier.
- HPV testing is more sensitive for high-grade cervical intraepithelial neoplasia (CIN) than cytology.
- Cervical cytology will become increasingly less effective as a primary screening test, as the numbers of immunised people in the screened population increase.
We have produced findings from research about women's understanding of HPV and cervical screening.
Jo’s Cervical Cancer Trust has also produced a guide for healthcare professionals on talking about HPV (external website).
Cervical screening and health inequalities
A person’s risk of developing cervical cancer increases if they are or ever have been sexually active, or if they smoke. This is because smoking makes the immune system less effective in fighting HPV.
Another important risk is missing their cervical screening appointment. Evidence shows lower participation in cervical screening 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
- trans men and non-binary people assigned female at birth.
In 2019/2020, uptake for those aged 25 to 64 in the least deprived areas was 75.5% compared with 65.3% in the most deprived areas. Uptake of screening is lowest in the younger age groups and increases with age to a peak at 50-54 years.
Practical barriers include being unable to make appointment times or lack of transport.
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.
People may have never attended cervical screening or they may be overdue their appointment. Some will also make an informed choice not to attend their cervical screening.
You can also find out more about uptake of cervical screening on Information Services Division’s Cervical Screening Programme page (external website).
Cervical screening toolkit
We have produced a toolkit to help GPs, practice nurses and practice staff to optimise uptake, reduce barriers and ensure people are making an informed choice.
The toolkit includes a range of best-practice approaches that you may wish to try to add value to existing work or optimise participation in your local area.
It also contains more detailed information about the Scottish Cervical Call-Recall System (SCCRS) (external website), the system health professionals use to support the cervical screening programme.
Cervical Screening Exclusion Error
NHSScotland has identified a number of people who may have been incorrectly excluded from cervical screening following a hysterectomy. Anyone affected by this error will be contacted in due course.
It is fully appreciated your patient may be worried by this error, however, please provide reassurance that the overall risk of cervical cancer is fewer than 1 in every 100 women in Scotland across their lifetime.
You can signpost your patients to the following websites and helplines for further information if they have any questions or concerns:
- Visit NHS inform (external website)
- Visit Jo’s Cervical Cancer Trust website (external website)
- Call the helpline for free on 0808 802 8000. In partnership with NHSScotland, Jo’s Cervical Cancer Trust has made its national helpline available to anyone with concerns. Patients can contact the helpline for information and advice. Please be aware Jo’s Cervical Cancer Trust does not have access to NHS records so will not be able to provide your patient with clinical information about their screening history or hysterectomy.
Please continue to remind people, whether they have been affected by this incident or not, to contact their GP practice immediately if they have any unusual discharge, or bleeding after sex, between periods or after menopause. There is also information about cervical cancer symptoms on NHS inform (external website).
NHSScotland has put measures in place to reduce the likelihood of this error happening in future. Extra sources of information are checked about the type of hysterectomy carried out and the need for ongoing cervical screening.
All records of people permanently excluded from the cervical screening programme will be individually reviewed and informed of the outcome. The programme is working to develop a safe and thorough process to ensure that all records are reviewed in the same way. The records will be prioritised for review on the basis of risk, informed by clinical advice. Records of individuals who have been excluded from screening for the longest period will be reviewed first.
Local and national action
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).
Scottish Government’s 2016 Scottish Cancer Strategy (PDF 1.17 MB) (external website) 'Beating Cancer: Ambition and Action' sets out a clear commitment to reduce inequalities in cancer screening.
Cervical screening standards
Healthcare Improvement Scotland (HIS) has produced a set of standards for cervical screening within NHSScotland.
To support practices to deliver the Scottish cervical screening programme to the highest standard, 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 sample takers in Scotland.
There are national Standards for Education providers: Cervical Cytology (PDF 1,559 KB) (external website) for education providers. General practices must ensure that all sample 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 takers in primary care.
Information for the public
With every cervical screening appointment letter, eligible people receive an information leaflet to enable them to make an informed choice about whether to attend their screening appointment. Leaflets are available in other formats and languages from NHS inform (external website).
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, HPV and cervical cancer.
Your Smear Test Results provides information about results of the test and any follow up that is required, as well as any treatment needed.
Your Smear Test After Treatment provides information about what will happen after cervical intraepithelial neoplasia (CIN) treatment.
A cervical screening poster encouraging eligible people to take up their smear test invitation is also available.
NHS inform hosts cervical screening information for the public. This includes a short film 'your guide to cervical screening (smear test)' explaining the screening process. It also provides information available in British Sign Language (BSL) and audio format.