Cervical cancer screening
The Northern Ireland Cervical Screening Programme aims to reduce the number of women who develop cervical cancer and the number who die from it.
It tries to do this by testing as many women as possible, examining the test results and referring the women for further treatment if any early warning signs are present.
Currently, women aged 25-49 are invited for screening every 3 years and those aged 50-64 are invited every 5 years.
The screening test (often known as a smear test) looks for abnormal changes in the cells that line the cervix. These abnormal changes may go on to develop into cancer if left untreated. However, in some cases, particularly young women, the body’s immune system will return the cells to normal by themselves, rendering them harmless.
Women under the age of 25 are not screened because the balance of risks and benefits is different than in older women. Cervical cancer is very rare in this age group, with only one or two cases occurring each year in Northern Ireland. Young women who are screened are more likely to have an abnormal screening test result and undergo further tests and treatments that they do no need. Unnecessary treatment can cause significant anxiety and, in some cases, lead to a higher risk of premature birth in future pregnancies.
Please note (updated 04 April 2023)
Temporary changes to the way cervical screening samples are processed in the laboratory have been introduced from March 2023. This is to manage the current backlog.
Co-testing has been introduced as an interim measure on all samples sent as part of the Cervical Screening Programme. This means samples will be tested in a two-step process as follows.
1. Human papillomavirus (HPV) testing (for specific ‘high risk’ types of HPV), followed by
2. Cytology investigation (examination under a microscope)
Step 1 will be used to prioritise samples for cytology. If the sample tests negative for HPV the chances of a patient developing a cancer are very low. However, under these arrangements, all specimens will still undergo cytology in due course.
The new temporary process aims to manage the clinical risk caused by delays in cytology investigations by identifying those patients who are at higher risk of cervical cancer.
Why test for HPV at all?
HPV is a very common group of viruses. They do not cause any problems in most people, but in some people, some types of HPV can cause:
- genital warts
- abnormal changes in the cells that can sometimes turn into cancer
HPV types linked to cancer are called high-risk types.
Testing for HPV is the most effective and accurate way of identifying women at risk of cell abnormalities. This method is recommended by the UK National Screening Committee (NSC).
Further information about HPV can be found here.
Is the addition of HPV testing a permanent change to the Cervical Screening Programme?
As part of the Cervical Screening Programme in Northern Ireland, HPV testing has already been used in specific situations since 2013. These temporary measures are to help manage the current delays in reporting screening results.
Separately, plans are also underway to change the system permanently so that all samples are tested for high-risk HPV (primary HPV testing). This will bring Northern Ireland in line with the rest of the UK.
Once primary HPV testing is introduced, samples sent for routine screening will only be prepared for cytology if HPV is detected.
Will the clinical procedure for taking a cervical screening sample change?
There will be no change to the clinical procedure for taking a sample.
Where can I find more information?
FAQs for the public on the temporary arrangements are available here: Temporary changes to the Cervical Screening Programme: frequently asked questions | HSC Public Health Agency (hscni.net)
FAQs for professionals are available here: Resources for Health Professionals | Cancer Screening Northern Ireland (hscni.net)
Cervical Screening in the Southern Trust Laboratory
The Southern Health and Social Care Trust provides a Cervical Cytology Service as part of the Northern Ireland Cervical Screening Programme. In July 2022, senior laboratory staff notified the trust’s management team that they had concerns about performance in some steps of their laboratory’s screening system. To fully investigate these concerns, the trust commissioned the Royal College of Pathologists (RCPath Consulting) to undertake an independent assessment of its cervical screening services from 1 January 2008 and October 2021. As a precautionary measure, the trust is undertaking a precautionary review of the results of some patients who had cervical smears analysed by the trust during this time period. To find out more information on this issue, visit www.southerntrust.hscni.net.