Cervical screening (the smear test) saves around 5,000 lives in the UK every year by detecting cell changes before they develop into cervical cancer. England has the highest uptake rates in the UK but participation has fallen in recent years — in 2023, only 69.4% of eligible women were up to date with their screening, below the NHS target of 80%. Understanding what cervical screening involves, why it matters, and what to expect can help more people attend.
What Is the NHS Cervical Screening Programme?
The NHS Cervical Screening Programme invites women and people with a cervix aged 25–64 for regular screening. The test looks for human papillomavirus (HPV) — the virus that causes virtually all cervical cancers — and checks for any abnormal cell changes in the cervix that might develop into cancer if left untreated. Cervical screening is not a test for cancer; it’s a preventive test that finds problems before cancer develops.
Who Should Attend and How Often?
| Age Group | Screening Frequency |
|---|---|
| 25–49 | Every 3 years |
| 50–64 | Every 5 years |
| 65+ | Only if recent tests were abnormal |
| Under 25 | Not routinely offered (HPV is very common in young women and usually clears naturally) |
You will receive a letter from your GP practice inviting you. If you haven’t received your invitation and are overdue, contact your GP surgery to book. You don’t need to wait for a letter — you can self-refer.
HPV — The Key Facts
Human papillomavirus (HPV) is an extremely common virus — around 80% of people will have HPV at some point in their lives. Most HPV infections clear on their own within 1–2 years without any symptoms or treatment. However, some high-risk HPV types (particularly HPV 16 and 18) can persist and gradually cause cell changes that may — over many years — develop into cervical cancer if undetected and untreated.
HPV is passed through skin-to-skin genital contact, not just penetrative sex. Condoms reduce transmission but do not eliminate risk completely. Having HPV does not mean you or your partner has been unfaithful — it can lie dormant for years.
HPV-Primary Screening (The Current NHS Approach)
England switched to HPV-primary screening in 2019 — a significant improvement over the previous cytology-only approach. The process is:
- Step 1 — HPV test: Your sample is first tested for high-risk HPV
- HPV not detected: You are at very low risk; return to routine recall (3 or 5 years). No further testing needed
- HPV detected → Step 2 — Cytology (cell check): The same sample is checked for abnormal cells under a microscope
- HPV detected, cytology normal: Repeat screening in 12 months (most infections clear by then)
- HPV detected + abnormal cells: Referred for colposcopy
What Happens During the Screening Test?
The test is performed by a trained nurse (usually your practice nurse or a specialist nurse at a sexual health clinic). It takes about 5 minutes:
- You will be asked to undress from the waist down and lie on an examination couch
- A smooth, plastic speculum is gently inserted into the vagina to hold the walls apart
- A small, soft brush is used to collect cells from the surface of the cervix — a quick sweep that takes seconds
- The sample is sent to a laboratory in a small pot of preservative liquid
Does it hurt? It may be briefly uncomfortable — particularly for those who are anxious, post-menopausal, or have never had penetrative sex — but it should not be painful. If you find it painful, tell the nurse immediately; they can adjust technique or offer a smaller speculum. You can also ask for a female clinician, bring a friend for support, and request a longer appointment to go slowly.
Understanding Your Results
| Result | Meaning | What happens next |
|---|---|---|
| HPV not detected | Very low risk; normal | Routine recall in 3–5 years |
| HPV detected, normal cells | HPV present but no cell changes yet | Repeat in 12 months |
| HPV detected, borderline/low-grade changes (CIN 1) | Minor cell changes | Colposcopy referral |
| HPV detected, high-grade changes (CIN 2/3) | Significant cell changes requiring treatment | Urgent colposcopy; treatment at same visit often |
| Possible cancer cells seen | Rare; requires investigation | Urgent colposcopy and biopsy |
What Is a Colposcopy?
A colposcopy is a more detailed examination of the cervix using a colposcope — a magnifying instrument that stays outside the body. A nurse or doctor applies a liquid (acetic acid or iodine) to the cervix to highlight abnormal areas. A biopsy may be taken for analysis. Results are usually available within 4–8 weeks. If treatment is needed, it is often performed at the same colposcopy appointment:
- LLETZ (Large Loop Excision of the Transformation Zone) — the most common treatment; removes the area of abnormal cells using a thin wire loop heated by an electric current; done under local anaesthetic; takes about 15 minutes
- Laser treatment — uses laser to destroy abnormal cells
- Cone biopsy — for larger areas; performed under general anaesthetic
HPV Vaccination and Cervical Cancer Prevention
The NHS HPV vaccination programme now offers the Gardasil-9 vaccine (protecting against 9 HPV types, including HPV 16 and 18) to all children aged 12–13 in Year 8. Catch-up vaccination is available to those up to 25 who missed their school vaccination. People assigned male at birth who have sex with men can also receive HPV vaccination up to age 45 via sexual health clinics.
HPV vaccination reduces the risk of cervical cancer by ~90%. However, vaccinated people must still attend cervical screening — the vaccine does not cover all HPV types and does not protect those already exposed before vaccination.
Symptoms of Cervical Cancer
Do not wait for your screening invitation if you have symptoms. See your GP urgently if you notice:
- Unusual vaginal bleeding — between periods, after sex, or after menopause
- Unexplained vaginal discharge that is watery, bloody, or has an unpleasant smell
- Pain or discomfort during sex
- Lower back or pelvic pain
Jo’s Cervical Cancer Trust (jostrust.org.uk) — helpline: 0808 802 8000; excellent support and information for anyone anxious about cervical screening or cervical abnormalities.
This article is for informational purposes only. Cervical screening is a personal choice — but it is one of the most effective cancer prevention tools available. If you are anxious about the test, speak to your GP or practice nurse about how they can make it more comfortable for you.
Related Health Guides on YourHealthXpert
Explore these related NHS-aligned health guides:
- Bowel Cancer Guide — Like cervical screening, bowel cancer screening is an NHS programme saving lives through early detection; understand how it works.
- Breast Cancer Guide — NHS breast screening (mammography) runs alongside cervical screening; learn about both programmes and when you’re invited.
- Endometriosis Guide — Symptoms like pelvic pain can mimic cervical conditions; understand the differences and NHS diagnostic pathways.
- Menopause Guide — Menopause affects cervical cell changes and HPV immunity; learn how the menopause transition impacts cervical health.
- Prostate Cancer Guide — Understand the male equivalent of cancer screening programmes and why regular health checks matter for everyone.
- HRT Guide — Hormone therapy can affect cervical health; learn what to discuss with your GP about HRT and screening.