Human papillomavirus (HPV) primary screening

On 6 July 2016, Public Health Minister Jane Ellison announced the introduction of HPV primary screening.

Background

From 2003, the NHS cervical screening programme (NHSCSP) (established by Department of Health in 1988) invited women for screening by their GP every 3 years if aged 25–49, and every 5 years for women aged 50–64.

Most cervical cancers are caused by human papilloma virus (HPV). Between 2011–14, testing for HPV was only done if mild or borderline results were found using routine liquid-based cervical cytology testing. However, a growing body of research supported HPV testing as a more accurate initial screening test, with cytology testing only done if the HPV test is positive.

HPV primary screening

HPV primary screening meant that screening samples would first be tested for HPV, with cytology testing following where HPV is found. The announcement followed a successful pilot programme that found reductions in cancers when using HPV testing as primary screening.

Responding to the announcement of the change in screening approach, Chief Executive of Cancer Research UK Sir Harpal Kumar stated: ‘Testing first for the human papilloma virus will help prevent more cervical cancers, as it can pick up the cancer-causing infection before any abnormalities can develop in the cells.’

Implementation

Coverage across the whole of England was initially planned for 2019, but the government and PHE later began referring to 2020 as the goal.

Implementing the change in testing contributed to increases in waiting times for cervical screening test results.

Providers had difficulties in meeting the 14 Day Turnaround Time (TAT) standard because they reduced the number of cytologists in anticipation of a reduced workload (since fewer are required for HPV primary screening) before full roll-out. In 2019, in a review of national adult screening programmes, Former National Cancer Director Professor Mike Richards stated that patients should receive results in standard timeframes once again after implementation had been completed.

Source(s)

Department of Health.
Changes to cervical cancer screening [webpage].
UK government; 2016.

Richards M, Thorlby R, Fisher R, Turton C.
Unfinished Business.
Health Foundation; 2018.

Ellison J.
Cervical Cancer: Written question – 11267.
UK parliament; 2015.

Churchill J.
Cervical Cancer: Screening: Written question – 556.
UK parliament; 2019.