In March 2020, cervical screening (smear) tests in Scotland changed. Human Papillomavirus (HPV) testing was introduced into the Scottish Cervical Screening Programme. Cervical cytology (looking at cells under a microscope) was replaced by HPV testing as the primary (first) screening test.
The Cervical Screening programme was paused due to COVID-19. The good news is that it has resumed and the new screening test is in place.
Cervical screening is offered to women and people with a cervix aged between 25 and 64 years. Some people are offered screening up to the age of 70 years if results from previous screenings show some changes need to be monitored.
Why introduce the new test?
In November 2015, following a review of the evidence, the UK National Screening Committee made a recommendation to the UK countries to adopt high-risk HPV primary testing into the Cervical Screening Programmes.
In March 2016 Scottish Government committed to implementing primary HPV testing which was included as an action in the cancer strategy plan.
The implementation of Hr-HPV Primary Testing was announced by the Scottish Health Minister on 11 August 2017 following approval of the Full Business Case.
The change sees the replacement of cervical cytology as the primary screening test with Hr-HPV testing and the use of cytology-based tests as the triage for women who test positive for Hr-HPV. How samples are taken will not change, it’s the way in which the sample is processed that is different. The sample will now be initially tested for Hr-HPV using an automated platform. Positive result samples will then have a cytology test carried out by examination of cells under a microscope.
Scotland’s cytology laboratory service was also reconfigured from the existing cytology laboratories and one HPV laboratory to two centrally commissioned laboratories to deliver both Hr-HPV and Cytology in both sites.
The Implementation Project officially commenced in September 2017. An Implementation Board was established and provided overall project governance and reported to the Scottish Screening Committee via National Specialist and Screening Services Directorate (NSD). Six Implementation Groups, to ensure successful delivery of the change, were also established. These were –
- Laboratory Reconfiguration Group
- Clinical Governance
- QA/EQA/Data Group
All Groups had a wide range of stakeholders as members.
Tracey Syme, Deputy National Screening Coordinator, explained the reason for introducing the new screening test: “HPV is the main cause of cervical cancer. During our lives, four out of five of us will get some type of HPV. Most of us will never know we had it. For a small number of women, their immune system will not be able to get rid of HPV. A persistent HPV infection causes the cells of the cervix to change. Testing for HPV before looking for cell changes is a more effective and accurate way of finding out if you are likely to develop cancer.
There are usually no symptoms with HPV or changes in cervical cells and sometimes no symptoms with early-stage cervical cancer. Even if you have no symptoms, cervical screening can help to find changes so that they can be monitored or treated. Finding these changes at an early rather than late-stage means that they're easier to treat and you are nine times more likely to survive cervical cancer. Cervical screening can stop cervical cancer before it starts and is the best way of finding out if you are at risk of
If HPV is found, the lab will then look at the same sample for cell changes. If cell changes are found these will be monitored or treated. If HPV is not found in the sample, the next screening test will be in five years, regardless of age. This is a change for women under 50, who used to be invited every three years. This is because evidence tells us that the risk of developing cervical cancer is very low”.
As a result of vaccinating girls and boys in secondary school against HPV and this new, better way of testing cervical screening samples, researchers predict that cervical cancer could significantly fall, or even be wiped out completely in Scotland in as little as 20 years.
As Tracey explains, “It really was a collaborative project – as well as my NSD colleagues, Digital and Security were involved in implementing the IT changes, National Procurement led on the procurement exercise and our Director of Procurement, Commissioning and Facilities, Jim Miller, chaired the lab reconfiguration panel.
“The collaboration also stretched further afield, with our colleagues in Public Health Scotland leading on the communications work and the changes to reports and data requirements”.
What the future holds for Cervical Screening
Across the UK, cervical screening attendance has been falling. Difficulty getting appointments, embarrassment, lack of time and having a physical disability are just some of the factors contributing to this trend.
One way to tackle this is by providing women with the option to self-sample. Self-sampling means women can take the test into their own hands and take a sample in the privacy of their own home. A self-sample will also test for HPV so it is the same as the new method of testing cervical screening samples.
You may have seen it called a few different things such as ‘DIY smear tests’, ‘HPV self-tests’ and ‘home-testing kits’ – essentially, they’re all the same thing.
Scotland will be feeding into evaluation work which is required to help the UK National Screening Committee to make recommendations on how best self-sampling can be implemented into a national screening programme. This could mean that the national screening programme will soon be able to offer self-sampling to all women. An amazing step forward.