HPV vaccination. The end of the smear as we know it?

[JustNotFunnyAnymore]

Just had a telephone conversation with a school nurse as I am concerned that DD will not be called for regular smears if she has HPV vaccination. This is what the letter on headed NHS paper to parents/guardians accompanying the HPV consent form states:-

"All women are currently offered twelve cervical screens between the ages of 25 and 64. Following vaccination your daughter will in due course be advised to have a cervical screening check at around the age of 30, and it is very unlikely that she would get an abnormal result. In fact she will probably only need two cervical screens during the course of her life because of the protection that she will receive from vaccination."

As this paragraph is in contradiction to the NHS leaflet also enclosed with the consent form which states within FAQ section that "All women should decide to go for cervical screening (smear tests) when they are old enough (25 and over in England)" I, not unreasonably I thought, sought clarification.

To be clear, I am not against this vaccination as I have been treated for this dastardly virus myself but I do not want DD to become complacent.

The nurse was very informative and advised that if she has the vaccination her records will be updated and between the ages of 25 and 30 she asked for a swab that she will be able to do herself. If she doesn't have the vaccine she will be treated as we are now and called for a smear. She knew little more about the 'swabs' but identified this as being what will happen.

This is the first I have heard of this and there is no supporting evidence in any of the accompanying literature although I have no doubt that the nurse was telling me what she knew to be the case.

I am wary of this because of my own experience.

As the vaccine only "protects women against the two main types of HPV that cause over 76% of cases of cervical cancer" - letter again - I would feel far more comfortable knowing that DD would be offered screening against the 24% not protected.

Does anyone know more and AIBU to question this?

YANBU - I'm sure Bella will be along with definitive info, but I am pretty certain that no decisions have been taken as to the future of the cervical screening programme at the moment, and I'd be very concerned about incorrect information being given out

I don't think you are unreasonable to question this change in policy. I think its a mistake to stop the cervical screening programme. We don't know how many years protection the HPV vacine gives. HPV will still exist as men are not being vacinated. Does the HPV jab give life time protection or do women need a booster in 10 years time? This vaccine is untested over an 80 year lifespan.

I didn't know, butvery interesting. It would be good to understand the rationale behind scaling down the screening programme; do they feel that there are other ways that the 24% of remaining cancers should be identified, or are they just feeling that the cost of continuing the programme is not justified given the 76% expected reduction in identified cancers?

ReallyTired - length of protection was one of the concerns I raised in my conversation this morning. The nurses response was that she had no idea how many years protection the current vaccines offer as they are relatively new. She could offer no knowledge as to how and when this information may be known but still insisted that "during their training session on Tuesday" they were told that vaginal swabs will be replacing smears for those who have HPV vaccination on their records.

Didn't reassure me I have to say.

Venetia - I had the very same discussion with DH the night before last. Cost v. risk. DD is 12. I can give her consent to have the vaccination now. When she is an adult the ball will be in her court. I will always feel responsible hence my needing answers now.

Women can have as many smears as they like. If they pay for them. Using public money to pay for tests that are unnecessary because you've already spent a lot of public money on a vaccine would be a huge waste of time and money.

They didn't decide this for the fun of it. It will have been extensively researched by experts first.

but not all cervical cancers are caused by hpv virus though whatyoulookingat and I think the issue is the nurse has sent out conflicting informtion so that is not very reasuring that it has been extensively researched.

This really worries me. I'm actually off to have a smear tonight, delightfully I get to have them every six months after some weird results a while back. I'm 28 and some of my similar age friends have never been for one because they just don't think it's important .

I feel like this sends a message that once you've had the vaccination, you're safe and you don't need to worry anymore.

OP can I ask please where in the UK your daughter's school is located? Would you mind awfully telling me which health authority?

Bear in mind that cost does not just mean money - it includes pain, discomfort and embarrassment for women who hate smears, and more importantly it includes treatment for false positives, which can have nasty side effects. At the moment we think the benefits outweigh the risks, but if you cut the numbers of actual CC cases by 3/4 and keep the number of false positives the same then the calculations may change.

In any case it's ridiculous for a nurse (or the information she was supplied with) to make pronouncements about what will happen in ten years time when the current cohort of teens reach screening age - who knows what will have happened by then? We might have discovered all sorts of things about the effectiveness of the vaccine, or indeed about prevention of the other 25% of CC cases.

whatyoulooking at the info provided with the HPV vaccine states that it covers 70% of causes of cervical cancer, it lowers the risk, doesn't eliminate it, so smear tests should be still carried out.
The info given in Scotland is to still have regular checks ( and we start at an earlier age )
www.healthscotland.com/health/topics/immunisation/HPV.aspx
www.immunisationscotland.org.uk/vaccines-and-diseases/hpv.aspx

I am worried about the implication in that letter that having the vaccine means smear tests aren't quite necessary. Only 2 in the course of her life? That can't be right

Okay, that's rather scary. I'm already that you aren't called for your first one until 25 in the UK, because growing up in the US we were urged to have one as soon as sexually active. I think I had my first with my first pill prescription at 17.

Do they require one with The Pill in the UK?

They don't require one at all Tee they're optional. They send out reminder letters to people of age, and the nurse will have a "sly comment" or two if she sees someone for something else and they are due or have missed one, but that's all. They can't coerce people into having one by witholding contraception that they would otherwise be prescribed.

EasilyBored - agree. DD hates the thought of a smear and initially was delighted that she was only going to have to have 2 in her lifetime. I am convinced she will remember what she has read despite my input. When an adult I really don't want her to think it's an unnecessary waste of her time etc. but what more can I do?

EasilyBored - ps, good luck with your smear tonight. I went through the same from my early 20's. The smears then went to yearly and now 3 yearly.

janinlondon - not at all, she is at school in Cheshire and the letter to parents/guardians is photocopied but headed 'East Cheshire NHS Trust' with NHS logo.

The NHS Cancer Screening Programmes wants to let people know that the guidance on cervical screening in England has not changed with the introduction of HPV vaccination. Women are still offered screening every three years from the age of 25 to 49, and every five years until the age of 64. It will be many years before the vaccination programme has an effect upon cervical cancer incidence so the Screening Programme is not planning any changes yet. Vaccinated women are advised to continue accepting their invitations for cervical screening (if they decide they want to be screened), as the vaccination will not prevent all types of cervical cancer.

For more information about cervical screening in England, please visit our website www.cancerscreening.nhs.uk/index.html.

For further details on the HPV Vaccination Programme, please visit NHS Choices www.nhs.uk/conditions/hpv-vaccination/pages/introduction.aspx?WT.mc_id=090805 or talk to your GP.

NHSCancerScreening - Many thanks for your input. Does this mean I can be confident then that when DD reaches 25 she will be called for a screening? The nurse seemed pretty confident when she told me that the girls who have the vaccination will be contacted sometime between age 25 and 30 and those who don't have the vaccine will be treated as we are now and def called at age 25. There was no doubt in her mind that the 2 groups would be treated differently.

If this is what the nurses are being taught in their training sessions then from whom does this information originate?

Still unsure tbh