Smear Tests

[GrandPrismatic]

Hello! Just been for my long overdue smear test and they explained the process had changed last year and now instead of automatically testing the cells, they screen for HPV and if it is not found, they don’t test the cells for changes…just invite you back in 5 years time for another screening.

They only test the cells if HPV is present as they state risk of developing cervical cancer is very low without HPV present.

Now….this seems to a non-medical type like me to be a bit…light touch? Given 4 out of 5 people will have or have had HPV (was told this by the nurse) then surely, even if your HPV had cleared, you may be at risk? The cynical side of me also thinks it must be easier and cheaper to screen for HPV rather than cell changes and it is driven more by costs. Given they already have the cell sample, is it really that much more effort to look for changes?

I’m feeling a bit….short changed?? Anyone with any knowledge of the topic able to reassure?

I had it explained in May when I finally got my overdue smear. I've had cells in the past so feel like they are going with a cheaper way instead of properly investigating them. It no longer has the security of every 3 years either.

This really surprises me. It's true that the vast majority of cervical cancers are caused by HPV infection (although I don't actually know whether the infection has to persist) but not all. My last smear was done privately as part of a routine health check, and they did both (virus and cells). It does smack of cost cutting to me rather than a clinically sound decision tbh.

Yes @Groovee it does feel cost driven. I don’t feel very reassured at all :(

Longer term the goal is to get kids vaccinated against HPV which should have a significant impact on future rates of cervical cancer, they will point to that as a signal of success. And indeed, I am delighted with that outcome.

But in the meantime….it feels like…for us middle-agers….let’s cut screening services cos the cavalry is coming anyway

I wonder if this is the same in rUK?

99% of cervical cancer causes by HPV
www.nhsinform.scot/healthy-living/screening/cervical/cervical-screening-smear-test

Key facts about HPV testing

The UK National Screening Committee (UKNSC) recognises that using HPV testing as the primary test in the cervical screening programme is a better way of identifying those at risk of cervical cancer.
More lives will be saved by determining a person’s risk and ensuring any changes are found and treated earlier.
HPV testing is more sensitive for high-grade cervical intraepithelial neoplasia (CIN) than cytology.
Cervical cytology will become increasingly less effective as a primary screening test, as the numbers of immunised people in the screened population increase.
www.healthscotland.scot/health-topics/screening/cervical-screening

So what I dont understand is if 4 out of 5 people have/had HPV, does their risk of cervical cancer disappear once they have fought off HPV?

Anyway….I’d like both! If I’m going to get a smear test then I’d at least like to know I have the highest possible chance of cervical cancer detection.

Yes, it's the same in the UK. The change came into place in 2020. I choose to do self-HPV tests at home as it's now the same.

It's nothing to do with cost cutting. It's a long overdue change that will save lives because it's more efficient and accurate. Also stop the trauma of being recalled for a false positive and fewer colposcopies.