Understanding HPV and cervical screening
Cervical cancer is preventable and curable. Sarah Butler and Yvonne Wilkinson explain how the cervical screening programme has changed from a cytology based test to HPV primary screening
Screening for human papillomavirus is now the primary test for cervical screening in England, Wales and Scotland. Cervical screening for those individuals with a cervix routinely occurs every 3 years for those aged 25–49 (24½ in England) and every 5 years for those aged 50–64. Over 99.7% of cervical cancers are caused by human papillomavirus. Cervical cancer is preventable and curable; primary HPV screening can detect early changes in cervical cells allowing for effective monitoring and treatment.
Cervical cancer is the fourth most prevalent form of cancer among women worldwide; in 2018 an estimated 570 000 women were diagnosed with cervical cancer and it was responsible for the death of 300 000 women worldwide, with almost 90% of the deaths occurring in low and middle income countries (World Health Organization, 2020a). In the UK, cervical cancer is the 14th most common form of cancer in women: around 3200 women each year are diagnosed with cervical cancer, which equates to over 8 new diagnoses each day (Cancer Research UK, 2020). The World Health Organization estimates that without any action being taken, incidence rates will increase, with new cases of cervical cancer rising to 700 000 and the number of deaths rising to 400 000 by 2030. However, cervical cancer is a preventable disease and is curable if detected early and managed effectively. The National Cervical Screening Programme has been in force in the UK since 1988 and is estimated to have saved 5000 lives each year (Stubbs, 2018) and the introduction of the human papillomavirus (HPV) vaccination in 2008 in the UK has been a further significant step in preventing cervical cancer. A recent study by Falcaro et al (2021) suggests the HPV vaccine is reducing cases of cervical cancer by almost 90% in England. Another study showed both a reduction in pre-cancerous growths and an 87% reduction in cervical cancer (Gallagher, 2021). The World Health Organization (2020a) have recently launched a Global Strategy to Accelerate the Elimination of Cervical Cancer. It identifies three key steps: vaccination; screening; and treatment. While it is acknowledged that vaccine uptake is relatively good in the UK, with almost 84% coverage in females completing a 2-dose schedule in 2018/2019 (Public Health England, 2020a), the estimated number of eligible women who attend for regular cervical screening remains low, with only 70.9% of eligible women aged 25–49 years and 76.4% of eligible women aged 50–64 years attending cervical screening as of March 2020 (Public Health England, 2021). The number of completed vaccination schedules and attendance for cervical screening are expected to be lower following the COVID-19 pandemic with school closures and the reduction in face-to-face appointments at GP surgeries during the national lockdown (Public Health England, 2021; NHS Digital, 2021). It is essential that this downturn is reversed both in terms of vaccination and cervical screening as we move towards the Global Strategy to Accelerate the Elimination of Cervical Cancer (WHO, 2020a).
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