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February 15, 2022

Impact of cervical cancer screening policy changes in the UK could be minimal

There are concerns increasing numbers of women missing cervical cancer screening could negate diagnostic accuracy improvements.

By GlobalData Healthcare

Screening tests (Pap test or Pap smear) and the human papillomavirus (HPV) vaccine are effective in the early diagnosis and prevention of cervical cancer. The UK’s National Health Service (NHS) conducts the Cervical Screening Programme for the early detection of cervical cancer. The NHS reports that the number of cervical cancer cases has not risen sharply since the programme was introduced in 1980. GlobalData epidemiologists forecast only modest growth in cervical cancer incident cases in the UK, with 3,200 cases in 2020 increasing to 3,300 cases in 2030, suggesting that the number of cervical cancer cases has stabilised in recent years.

Based on the success of screening programmes, the UK is planning to extend the screening interval from three years to five years for women aged 25–49 years. UK health authorities recommended this change as new evidence showed it was safe to extend the time between cervical screening tests for people who are HPV negative. The proportion of women taking Pap tests has, however, declined in recent years, and there are concerns that improvements in diagnostic accuracy will be negated by an increasing number of women missing the cancer screening test.

According to Public Health Wales, current evidence suggests that women have a very low risk of developing cervical cancer within five years if no high-risk HPV is found during routine screening. But there are also concerns that extending the screening interval will not help women who do not attend screening appointments. In 2018, Public Health England raised the alarm that millions of women in the UK had not had a cervical screening test for 3.5 years. In the UK, around 72% of women aged 25–64 years had a cervical screening in 2018 within the period recommended for their age, which is less than the 76% of women who were screened in 2012.

Various factors are related to women not attending screening appointments in the UK. For example, women may be unaware of the test or embarrassed to discuss it with their primary care physician. Some women may also ignore advice for screening, as they view the probability of cervical cancer as remote. The Covid-19 pandemic has also had an impact and led to a substantial reduction in preventive healthcare, including HPV vaccinations and cervical cancer screenings. Preventive services, including adolescent vaccinations and cancer screenings, were frequently curtailed during stay-at-home restrictions caused by the pandemic.

The NHS’ target is for 80% of women aged 25–49 years to be tested every three years, and for women aged 50–64 years to be tested every five years. Policy changes will extend the testing interval for women aged 25–49 years to every five years. The proportion of women taking a Pap test has, however, steadily declined over the past decade. To reach 80% of the target population, women should be encouraged to take a screening test, sent a reminder and be offered additional screening appointments, including evenings and weekends, at convenient locations.

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