To think the new cervical screening system will miss cancer cases

[PeasAndFlour]

I think the new system is a blunt tool without room for nuance. E.g. if someone has hpv, then in the next smear they don’t, the previous hpv could have caused cell changes before the infection cleared but these aren’t picked up on, because the cells aren’t looked at anymore.

Privatisation through the back door. This will push women to go private if they have had previous complications.

I'm sorry I don't understand but this is a topic very close to me at the moment. I'm not aware of any change in practice at my local surgery. DO you have a link?

@dudsville All they do is check for the HPV virus. If it's not present then you don't get any more smears. That's what nurse told me last year.

Yes, I believe you may be correct - hadn’t occurred to me, even as someone previously diagnosed with hpv and cell changes. Will be asking my surgery for clarification - if true it’s a ridiculous idea and I am gobsmacked.

Yeah, if there's no HPV, they don't even look at the cells. Given how many women hate having a cervical smear, it just feels even more depressing that you agreed to an intimate test that is then not checked. Surely we could have a home test for HPV and then book a smear if positive?

My understanding was that they only check your sample for HPV - if HPV is shown, then they look at the cells gathered at the same time to see if they show abnormalities.

If you don't show HPV, then you are called back on the usual schedule (3 to 5 years).

There's a good summary of how the program works www.gov.uk/guidance/cervical-screening-programme-overview here, as well as the evidence base around swapping to HPV only initial testing.

My thought is that if they are mainly doing HPV only testing... why do the big smear palava though. Surely they should just do a HPV test, and call you back quickly if needed to get a cell swab to check for abnormalities.

I was a bit annoyed at my last screening when the (very lovely!) nurse explained they just test for HPV now. Why scrape my cervix at all then? I’d rather do a HPV test at home then go for a smear if it’s positive. It doesn’t sit right with me that they still scrape your cervix for what amounts to no reason for most women now.

@Blinkingbatshit

Yes, I believe you may be correct - hadn’t occurred to me, even as someone previously diagnosed with hpv and cell changes. Will be asking my surgery for clarification - if true it’s a ridiculous idea and I am gobsmacked.

I asked my surgery for clarification and am waiting for a response. The GP wasn’t aware of the new system.

[quote BirdOnTheWire]@dudsville All they do is check for the HPV virus. If it's not present then you don't get any more smears. That's what nurse told me last year.[/quote]
No, that’s not right. You’ll still be called at your regular screening interval. The change has been that if you don’t have HPV at screening, they won’t then test the sample you gave further that time around.

What the hell !! I’ve just had mine done this week
Which I hate

So who can the government be done without doing a smear ?
Can it be done via a blood test or would it have to be a swab up the vag or something ?

What’s the print of going through the smear if they don’t even look at the feels

My thought is that if they are mainly doing HPV only testing... why do the big smear palava though. Surely they should just do a HPV test, and call you back quickly if needed to get a cell swab to check for abnormalities.

This. I think I'm going to order a home HPV test, and only arrange a smear if that comes back positive.

HPV testing is more accurate than the traditional smear.
99.8%
The screening is not 100% for either test.
11 in 100,000 women develop CC in between smears/ tests or have a type of CC not picked up on a smear.
Personally Im still ok with having a smear as the nurse still has to look at your cervix to do the test and many cancers are picked up this way.

There was a programme on R4 last night talking about this. Inside Health I think? It worries me too.

I should add that you will be followed up more closely if you have HPV or cell changes.

They are looking for HPV in the cells of your cervix. It's actually much better at picking up who is at risk for cervical cancer than just looking at the cells.

It's been part of the test for ages, and it's backed up by data showing that this will pick up more cancers, and earlier, than just looking at the cells for changes.

There is the downside that it will miss the very tiny fraction of a percentage of cervical cancer that is not connected to HPV. But if you have symptoms you would still be able to get a smear and other investigation to pick this up.

Sorry my question should have read

Can a hog test be done without a smear
Is it just a swab up the vag or a blood test or what ?

I’m guessing the reason they still swab the cervix and don’t do just do an HPV test with smear follow ups for the positive patients is because there are then two opportunities for people to not show up so more might slip through the net. In other words you might make the effort to organise an HPV test but then not have time etc, to arrange the follow up smear if you are positive. Plus there would be further delays. At least as it stands, they have the cells there and they can test them quickly if you are HPV positive.

I agree though that I’d far rather they kept the old system and tested all cells regardless.

@LovelyYellowLabrador

Sorry my question should have read

Can a hog test be done without a smear
Is it just a swab up the vag or a blood test or what ?

HPV can be detected through a swab, yes. Currently trials are running in London of home HPV swabbing and only going for the Smear if the swab is positive.

This isn't a new system by the way, it's been in place for several years, but those going for smears this year may well have not heard about it as 3 years ago we were still doing the full test.

Screening is about both effectiveness and value for money. The new system is good, but more should be done to get the message out of how it works as many women still aren't even aware of HPV.

I explain all this to every patient I do the smears for (and no, our GPs don't all know this new system as they don't often do smears).

@JustOneMoreNameChange ah, that makes sense. Why not both test for HPV AND look at the cells for everyone though? Wouldn’t that also cover that tiny minority?

I’m guessing the reason is cost…

@RagzRebooted what happens to women who have had hpv in a previous smear, which has had the potential to cause changes, but is a negative hpv in the next smear? Is it not “cost effective” anymore to check their cells?

I believe it's been this way since early 2020? Maybe end of 2019.

The theory is the vast majority of cases are caused by HPV, so checking everyone's cells creates a huge amount of work for v v little benefit.

If you test negative for HPV you will be invited to next smear at 3/5 years depending on your age.

There’s so much research stating that HPV takes on average 10-20 years to cause cancer. So testing for HPV every 5 years and then doing more tests for those with HPV is actually more effective at picking up cancer earlier than the 3 yearly smears we had previously, which didn’t look for HPV. Only abnormal cells.

[quote PeasAndFlour]@RagzRebooted what happens to women who have had hpv in a previous smear, which has had the potential to cause changes, but is a negative hpv in the next smear? Is it not “cost effective” anymore to check their cells?[/quote]
"Women who have a HPV positive screen with a cytology negative result, will be recalled in 12 months for a further screen. Women who have a HPV positive screen with an abnormal cytology result are referred to colposcopy."

So if you are positive they check cells again 12 months later

@EarlGreywithLemon

I’m guessing the reason is cost…

The reason is cost vs benefit. Its not a 100% system either way. However testing for HPV and increasing the follow up for those women is more accurate. If you have HPV you will be sent for Colposcopy and have yearly testing until clear.

Sorry HPV and abnormal cells