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What is cervical screening?
Cervical screening (which used to be called a smear test) is a free test on the NHS to help prevent cervical cancer. It is not a test to diagnose cervical cancer. All women and people with a cervix are eligible for cervical screening between the ages of 25-64.
Currently in England you are invited for routine cervical screening every three years between the ages of 25-49, then every five years until you are 64. In Scotland and Wales, the screening intervals have already changed for all ages to be invited every five years.
NHS England has announced that from 1 July 2025 all women and people with a cervix of screening age (25-64) will be invited every five years in England, unless they are at a higher risk of cervical cancer because of high-risk Human papillomavirus (HPV) and/or cell changes, when they will be seen more often.
Why the changes?
Since cervical screening was first launched in the UK, in 1964, our knowledge of what causes cervical cancer, and the tools we have to help prevent it, has changed dramatically. We now know that HPV causes nearly all cervical cancers. We also now offer a vaccination against certain strains of HPV to girls and boys ages 12-13 in schools, and the cervical screening programme has evolved several times over.
These progressions and improvements to vaccination and screening have meant that the UK National Screening Committee is able to recommend inviting people to cervical screening ever five years, instead of every three. The new system will offer a more personalised approach to cervical screening based on your risk. If you’re low risk and haven’t had a high-risk HPV positive screening result recently, you will be invited every five years. If you have HPV, or have had it recently, you will be seen more regularly.
What is HPV?
Human papillomavirus (HPV) is a common virus. It is passed on through skin-to-skin sexual contact. This includes sexual touch, oral, vaginal and anal sex, and sharing sex toys. Because the virus is passed on through skin-to-skin contact, it is easy to get and difficult to completely protect against. 8 in 10 of us get HPV at some point in our lives. Most of the time, our immune system gets rid of HPV within two years without it causing any problems.
There are over 200 types of HPV, and they are split into two groups:
- low-risk HPV (which can cause warts on your hands or feet, or genital warts)
- high-risk HPV (which can cause certain types of cancer)
HPV and cancer
Having high-risk HPV does not mean you have, or will get cancer. In most people, HPV will go away without causing any problems. If high-risk HPV doesn’t go away, it is called a ‘persistent infection’. It can lead to certain types of cancer:
- cervical cancer
- vulval cancer
- vaginal cancer
- anal cancer
- head and neck cancers
- penile cancer
Nearly all cervical cancers are caused by high-risk HPV.
HPV vaccination
Since 2008 girls in year 8 at school have been offered a vaccine against certain strains of HPV. The vaccination programme was extended to boys in 2019. For those who missed out on the vaccination at school, there is a catch-up programme. The HPV vaccine is available free on the NHS until the age of 25 through GP practices and up to 45 for some people who may be at a higher risk. The vaccine is also available privately until the age of 45.
The HPV vaccine is a safe and effective way to protect against HPV-related cancers. Evidence shows the vaccine has already cut cervical cancer rates by 90% in England. In Scotland, there hasn’t been a single case of cervical cancer in women who were vaccinated since the schools’ programme was introduced for girls in 2008.
Cervical screening is still a very important part of trying to prevent cervical cancer. This is because, even though the HPV vaccine is showing to be very effective, it doesn’t cover all strains of HPV. Cervical screening is also very important for older women who would not have had the vaccine.
Progress in cervical screening
In 2019, cervical screening changed from cytology to HPV primary testing. Cytology tests look at cervical cells under a microscope to find changes that could develop into cancer. HPV primary testing looks for high-risk HPV, the common virus which causes nearly all cervical cancers.
If you are high-risk HPV positive, your sample will be checked for any cell changes. If these are present, you will be referred for a colposcopy which takes a closer look at your cervix.
If you are HPV positive with no cell changes, you will be monitored regularly. If you are HPV positive with or without cell changes, you will not fall into the five-year screening recall.
Several European studies found that primary HPV screening offers much greater sensitivity than cytology, 20% more. This means that HPV primary testing will be picking up more women and people with cervixes who are at a higher risk of cervical cancer, and picking them up earlier, than the previous cytology test.
It usually takes a long time for this persistent HPV to develop into cell changes, often five years or more. And even longer if it goes on to develop into a cancer. This is why some women and people with cervixes are found to have cell changes, or a cancer may occur, many years or even decades after they last had any sexual activity, or sex with a new partner.
The evidence behind the changes
One of these large-scale studies was the ARTISTIC trial, done across England. This showed that because HPV primary screening is much more sensitive, those who don’t have HPV could be screened less often. This would not apply to women with high-risk HPV who are at greater risk and would be checked more regularly.
If you’re HPV negative, then you are at a very low risk of cervical cancer, lower risk than if you had a negative cytology result (no cell changes). Research has shown that if you are HPV negative you are very unlikely to develop cervical cancer within the next ten years. Researchers at Kings College London found that screening every five years instead of three was just as safe and prevented just as many cancers.
Cervical screening is not a ‘one size fits all’ programme – and the evidence shows that we can treat those at low risk and high risk appropriately. We have made progress with HPV primary testing and because of its higher sensitivity, we are more likely to catch more women and people with a cervix at higher risk of cervical cancer earlier.
Our understanding of how cervical cancer develops has increased a great deal over the last 30 years. The new guidance is good news for those at low risk in England, they will no longer need to go for cervical screening as often. For those at a higher risk because of HPV and/or cell changes, please be reassured you will still be seen more often or treated. Every single case of cancer that can be prevented, should be. We want every person eligible to feel informed and empowered to attend vaccination and cervical screening when they are invited. The challenge we face is to ensure that everyone feels informed and supported to go to their cervical screening when invited.
-Athena Lamnisos, CEO, The Eve Appeal
Your frequently asked questions
We answer some of your most frequently asked questions about the changes announced to the cervical screening programme.
What is changing?
At the moment in England, women and people with a cervix aged 25-49 years are routinely invited for cervical screening every three years. But now we have a better test for HPV, the UK National Screening Committee (UKNSC) has recommended that those testing negative won’t need to come for a cervical screening quite so often – every five years instead of every three. If your cervical screening shows you have HPV, you may be invited for more frequent screenings to monitor any cell changes.
Why are cervical screening intervals changing?
The Human Papillomavirus (HPV) causes nearly all cervical cancers. We now use a test which is more sensitive and accurate than the previous method (a cytology test, which is sometimes called a smear test) to look for HPV in your sample. This helps us offer a more personalised approach by finding out who is at higher risk of developing the cervical cell changes that over time, if left untreated, could lead to cervical cancer. This change from three to five yearly screening is backed by robust scientific evidence. Studies have shown that if you test negative for HPV you are extremely unlikely to go on to develop cervical cancer within the next 10 years. So now we have this better test, you don’t need to be screened as often if you don’t have HPV.
When is this change happening?
This is happening from 1 July 2025 – so anyone who is screened on or after this date, and tests negative for HPV, will move to five yearly screening unless previous screening history suggests they should be screened more regularly. If you are being screened before 1 July 2025 and test negative for HPV, you will stay on the current three yearly recall until you’re next due a screen in three years’ time.
Will everyone move onto this new five yearly screening pathway automatically?
No. Next test due dates will not be changed retrospectively; you will be invited at the interval in which you were advised of at the time of your last test.
Only those who attend cervical screening on or after 1 July, and meet the clinical criteria, will have their next test due date set at five years. NHS England made this decision based on clinical advice from experts.
Those aged 50 to 64 are already invited every five years.
So will everyone aged 25-49 move to a five year screening if they test negative after 1 July?
No, not everyone. If your test result is negative but your last test (taken within the last five years) showed an HPV positive result, you will still be invited for screening in three years time so that we can continue to monitor your HPV status. If you test negative for HPV at that next test, then you’ll move to five year screening.
What happens if I test positive for HPV?
It’s important to remember that having HPV does not mean that you have or will develop cervical cancer. It is a common virus that most people will have at some point in their life without knowing, which usually goes away on its own. If HPV is found in your sample and there are no cell changes, you are invited for screening again in one year.
If cell changes are found alongside HPV, you are referred directly to a hospital clinic for a colposcopy to check the cervix more closely. Further follow up and treatment will depend on the colposcopy findings.
What happens if I test negative for HPV?
For most people, their screening result is normal, with no HPV detected. Screening results letters for HPV negative samples taken on or after 1 July 2025 will clearly state the date that your next test will be due, which will be in five years.
If you test negative for HPV, but you have had a positive HPV result within the last five years that has not already been followed up by a negative HPV test, you will be invited for screening in three years. The date of your next test will be stated in your results letter. If this test is negative, you will then be due in five years. This is so that they can make sure you are still HPV negative before you move to the longer interval, having had HPV in the recent past.
I’m currently having treatment following a colposcopy, will I be put on five-yearly screening?
Not immediately. You will be followed up according to the reason for your treatment. Once this is completed successfully you will move to five yearly screening.
I’ve had cervical cancer in the past, will I be put on five-yearly screening
Most people diagnosed with cervical cancer receive follow-up care and monitoring by their hospital cancer team instead of returning to regular screening. Those people who are diagnosed with very early cervical cancer and remain in the Cervical Screening Programme will go onto five year routine recall once their 10 year follow up is successfully completed.
I’ve never been for cervical screening, even though I am eligible. Will I now move onto a five-year recall if I do decide to come for a test?
Yes, if you come for screening and test negative for HPV you will be invited again in five years time.
I’m 25 and have been invited for my first ever screening. Will I automatically go straight onto a five-year recall if I test negative?
Yes, if you test negative for HPV at your first ever test aged 25, your next test date will be in five years time.
I haven’t been for screening for a long time, I’m overdue – will I now automatically be screened every five years?
Only those whose most recent test result was reported as HPV negative, and where they have no recent HPV positive history, will move to five yearly screening.
If we don’t have an HPV test result for you (because your last screening took place before the NHS started using the HPV test in 2019), your next test due date will remain set at three years until you come for screening, where we can check for HPV.
If you missed your last cervical screening, even if it was weeks, months or years ago, book an appointment with your GP practice now – it is not too late.
I’ve heard that I will be invited for my cervical screening through the app, but I don’t have it/don’t want it, what should I do?
From June 2025, you can receive cervical screening communications via the NHS App. Please download the NHS app and make sure your notifications are switched on. If you don’t want to use the App, they’ll attempt to contact you by text message. If they can’t reach you through these methods, they will send a letter through the post. So don’t worry, you won’t miss an invitation.
If you have any issues with the NHS app, visit https://www.nhs.uk/nhs-app/nhs-app-help-and-support/
I’ve had an HPV vaccination, do I still need to have cervical screening?
Even if you’ve been vaccinated, it’s important that you attend your cervical screening appointment when invited, because the HPV vaccine doesn’t protect against all strains of HPV.
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More information and advice
We have lots more information and tips on cervical screening, HPV, and cervical cancer. You can also speak to our Ask Eve nurses for free to chat about any worries or questions.
