Primary HPV cervical screening introduced in Northern Ireland

Service Development and Screening
Primary HPV cervical screening has been introduced in Northern Ireland

The Northern Ireland Cervical Screening programme has introduced full primary HPV testing into the cervical screening pathway. The full integration of HPV testing brings Northern Ireland in line with similar programmes in the rest of the UK and Republic of Ireland.

Between 2016 and 2020 in Northern Ireland, an average of 81 people were diagnosed with cervical cancer each year, and there were around 21 deaths from cervical cancer annually. Nearly all cervical cancers are caused by persistent infection with human papillomavirus, known as HPV.

Dr Joanne McClean, Director of Public Health at the Public Health Agency (PHA), said: “This is a significant milestone for cervical screening and will increase our ability to detect early cell changes that could lead to cancer. Our screening programme is very effective and over the past three decades has saved many lives, and this step forward in how we deliver the programme is great news.

“The way the smear test is carried out will not change, and it’s important that women attend for cervical screening when invited. The only difference is that now, all samples will be checked for the high-risk types of HPV in the first instance, and if the virus is found to be present, the sample will then go for further examination. This is a more agile and focused model which will also enable results to be delivered for most women much more quickly.

“Cervical cancer is one of the few cancers that can be prevented thanks to screening and we are confident that this method of testing will enable us to drive down rates of cervical cancer in Northern Ireland further, along with the ongoing delivery of the HPV vaccination programme. We continue to strongly urge women to attend for cervical screening when invited as it could be life-saving.”

Professor Lourda Geoghegan, Deputy Chief Medical Officer at the Department of Health welcomed the full introduction of HPV testing: “The full integration of primary HPV screening signals a new era for cervical screening in Northern Ireland. The programme is now using a test which is more effective at detecting who is at higher risk of developing cervical cancer and will help save more lives.

“This programme development was set out in our Cancer Strategy for Northern Ireland and it is encouraging to see it now fully implemented in our cervical screening pathway.”

Martin Hunt, Chief Executive at Jo’s Cervical Cancer Trust, added: “We're thrilled that primary HPV screening is being introduced in Northern Ireland. This more sensitive and more effective test will help identify those at a higher-risk from an earlier stage, and will prevent more cervical cancers and save lives. For more information about HPV, cervical screening, screening results, and cervical cancer, visit www.jostrust.org.uk.”

Cervical screening, as with all screening programmes, doesn’t guarantee that cancer will not develop in the future, although it significantly reduces the chance. A cancer could develop between screening tests, and there is a small chance that the screening test misses some changes in the cervix.

Anyone who is concerned about symptoms, should seek advice from their GP, even if they attend regularly for screening. Signs and symptoms of cervical cancer can include any of the following:

  • vaginal bleeding after sex, between periods or after the menopause;
  • vaginal discharge that is not normal for them;
  • persistent back or tummy pains;
  • pain during sex.

Northern Ireland’s cervical screening programme will now be significantly strengthened through the introduction of primary HPV testing. Continued high uptake of this screening programme, together with maintaining a high uptake of HPV vaccination, will help ensure we continue to drive down cervical cancer rates further in Northern Ireland.

Please see the following websites for further information.

See link to a downloadable animation explaining the change - https://vimeo.com/892265209/da9d8262c4?share=copy

Background information

What is cervical screening

Cervical screening involves taking a sample of cells from your cervix for testing. It is also known as a smear test. The sample is checked for high-risk types of HPV that can cause cell changes. If high-risk HPV is found, your sample will be checked for cell changes under a microscope.

Most types of cervical cancer take a long time to develop. By finding cell changes early, screening can prevent cervical cancer from developing. Women and people with a cervix aged between 25 and 49 years old are routinely invited for cervical screening every three years, or every five years for those between 50 and 64.

What is HPV

Almost all cases of cervical cancer are caused by a virus called human papillomavirus (HPV). This is a very common virus – about 8 out of 10 people catch it at some time in their lives. The virus usually causes no symptoms and is mainly spread by skin-to-skin contact during sexual activity. In most cases, the body’s immune system will clear the virus and it doesn’t cause any problems, but in some people the virus can stay in the body for many years

HPV is generally spread by skin-to-skin contact. For HPV in the cervix, this is through sexual contact with a person of any gender. This can be by having vaginal, anal or oral sex, genital touching or sharing sex toys. Only certain types of HPV can cause cervical cancer. These are called high-risk types. The types of HPV that cause cervical cancer do not have any symptoms.

Having HPV does not necessarily lead to cell changes or cancer. In around 9 out of 10 people, their body will clear the infection naturally within two years.

However, in a small number of cases HPV in the cervix can develop into a persistent infection. Persistent infection with high-risk HPV can cause the cells on your cervix to change, and these changes can develop into cervical cancer.

HPV testing was already in place as part of an interim model introduced in March 2023 to manage a backlog and delay in cervical screening results coming back. This model also included a further examination under a microscope, known as cytology.

Now, all samples will be sent only for primary HPV testing which will facilitate the eradication of the backlog by removing the need for all samples to also undergo cytology. Nearly all cervical cancers (99.7%) are thought to be linked to persistent infection with high risk HPV. This approach is in line with the recommendations of the UK National Screening Committee as an HPV test has been shown to be better than cytology at identifying those most likely to have cervical changes. Most people will not have HPV (meaning their result is negative), which means their risk of getting cervical cancer is very low, so they do not need any further tests to check for abnormal cell changes in the cervix. They will be invited for another routine screening test in three years’ time if they are aged 25 – 49, or five years’ time if aged 50 – 64.

If high-risk HPV is found, the sample will be checked for cell changes under a microscope. If no cell changes are found, the individual will be invited for another test in 12 months’ time. If cell changes are found, the person will be referred for colposcopy – a closer examination of the cervix.

Women and people with a cervix aged between 25 and 49 years old are routinely invited for cervical screening every three years, or every five years for women between 50 and 64.