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Cervical smear intervals moved from 3 to 5 years with HPV testing. Why?

In short, screening every three years with cytology is as effective as screening every five years with HPV.

AFTER HPV-FIRST testing was introduced in the CervicalCheck programme in March 2020, the intervals at which the majority of women were taking smear tests increased from three years to five years. 

Many women who fall in the category of eligible for screening may wonder why – particularly after years of the cervical screening programme being under the microscope. 

This seems to be borne out by Labour TD Alan Kelly who said that it is something he has been contacted about by members of the public.

“I do think that something that has got lost a bit is the move from 3 to 5 years… people need to explain why that is the case. It is something that has come to me.”

The advice for HPV-first cervical screening in Ireland is:

  • If you are aged 25-29, you should be screened every 3 years.
  • If you are aged 30-65, you should be screened every 5 years.

Before that, when cytology smear testing was in place, women aged 25-44 were invited by CervicalCheck for a smear test every three years, unless they had a history that would mean they needed to be screened more regularly.

Woman aged between 45-60 were invited every five years.

The thinking behind the increase in intervals

Professor of Cancer Prevention Peter Sasieni explained in a blog post that the three-year intervals for cytology-first screening and five-year intervals for HPV-first screening is based on the stage of progression of pre-cancerous cells.

Several studies have shown that the risk of pre-cancerous lesions within six years of a negative HPV test is similar to the risk of pre-cancer within three years of a negative cytology test, he notes, which is the reason for those intervals being chosen.

On the broader point of why we don’t screen more often to find more cancers, Professor Sasieni makes the point this way:

The UK’s National Screening Committee has recommended HPV testing every 5 years from age 25 to 64. They anticipated that 3-yearly rather than 5-yearly HPV testing from age 25-49 would result in 151 fewer cancers and 19 fewer deaths each year in the UK.
Three-yearly screening requires just over 1 million additional screens each year across the UK. Thus, it takes about 55,000 additional screens to prevent one additional cervical cancer death. Even if those women died on average 45 years prematurely, each additional screen would, on average, result in an additional 7 hours of life.

He added:

For comparison, if instead of doing an extra million tests a year in relatively well-screened women, we did an extra 120,000 tests a year in under-screened individuals to ensure that 90% of the eligible population are screened at least once every 10 years between 25 and 49, we could prevent an additional 705 cervical cancers each year.

There is also a cost-benefit argument here as well: if a health service is to make an argument for more investment in cancer services, would that money be best spent on cancer screening, instead of investing in cancer treatments, colposcopy services, or training more cytologists and gynaecologists, for example.

Dr Nóirín Russell said that the reason for the change to the intervals as part of the move from cytology testing to HPV testing is that not all women are at equal risk.

“If you are HPV negative, we know that that’s much better than having a negative smear, it’s a much better predictor that you are at low risk of developing cervical cancer. And that’s why the interval is 5 years and we know that the science backs that up.

“That doesn’t mean that you’ll never develop cervical cancer, but it means that you’re in that low-risk category. The role of screening is to divide you into a higher risk, or normal risk. And if you’re in the normal risk category, screen negative or HPV negative, then it doesn’t matter how often you do your test, you still stay in that ‘normal’ zone.

When you get a HPV-negative test, it should make you feel ‘that’s that bit sorted, I’m at low risk. I still need to know about symptoms, and if I get them, I may need a diagnostic test, but there isn’t a role for more screening in my life, because it won’t benefit me’.

“The underlining thing here is understanding what screening can and can’t do for you.”

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21 Comments
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    Mute Patrick J. Keating
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    Apr 18th 2022, 9:15 AM

    I’ve no medical experience whatsoever, but I’d be of the opinion that a lot of changes could happen to a person in 5 years. It seems like a long interval between tests.

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    Mute D. Memery
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    Apr 18th 2022, 9:57 AM

    @Patrick J. Keating: my reading of the science, from the article, is that in effect the HPV test detects potential cancer earlier, and that by extending the intervals more testing can be concentrated on people at medium to high risk of developing cancer.

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    Mute Rmaybe
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    Apr 18th 2022, 10:23 AM

    @Patrick J. Keating: if you are hpv negative then the risk of developing cervical cancer is low therefore the intervals are further apart. If you are HPV positive then the risk is higher then the intervals are closer together so you can be monitored of any changes. Having the HPV veirsus does not mean you will get cervical cancer but not having the HPV virsus means you are unlikely. Hense the difference in interval times so the resources can be put to those who need it most.

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    Mute Alan Peters
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    Apr 18th 2022, 11:32 AM

    @Rmaybe: if you’re HPV negative you should be getting the vaccine.

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    Mute Rmaybe
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    Apr 18th 2022, 2:20 PM

    @Alan Peters: this is not true. Apart from the fact that there are not enough enough safety studies for women over the age of 26 receiving the vaccine, it not being detected in your smear does not mean you have not had previous exposure nor does it mean it will be effective and at €690 for a 3 shot course it’s out if the reach of many women. Regular screening is currently the best precaution for older women who are already sexually active.

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    Mute natasha
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    Apr 19th 2022, 1:54 PM

    @Patrick J. Keating: probably best to leave it up to those who do have medical experience so.

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    Mute Lynn Mcdonald
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    Apr 18th 2022, 9:25 AM

    This was changed practically by stealth…a lot of women dont know about this change. The previous smear tests tested for abnormal cells as well as HPV. Now we are only testing for HPV and only when a positive result is recorded do we then investigate further regarding these abnormalities. After all of the scandal regarding cervical check I’m amazed anyone is still using the service. I pay privately in Northern Ireland for full screening every 3 years (or as often as I choose)

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    Mute John O Connor
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    Apr 18th 2022, 11:38 AM

    @Lynn Mcdonald: Irish health service run by Irish that’s what you get

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    Mute Niamh Muireannín
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    Apr 18th 2022, 12:57 PM

    @Lynn Mcdonald: The old smear tests tested for abnormal cells, never for HPV unless there were abnormal cells present. The thing is HPV is the biggest cause of cervical cancer. But a person may potentially have had HPV but yet not developed abnormal cells so could have gone on to develop cervical cancer by the time the next smear came around. So this screening is actually better.
    https://www2.hse.ie/screening-and-vaccinations/cervical-screening/what-cervical-screening-is.html

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    Mute Rmaybe
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    Apr 18th 2022, 2:46 PM

    @Lynn Mcdonald: any women who go for their smear test are given this information

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    Mute Mike Dunne
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    Apr 18th 2022, 9:48 AM

    Five year testing intervals will mean more preventable deaths. A very bizarre decision.

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    Mute D. Memery
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    Apr 18th 2022, 10:02 AM

    @Mike Dunne: according to the studies referenced in the article, if even 10% of capacity generated were then focused on the higher risk cohort it will actually save 554 lives overall each year, I’m assuming these are UK figures however.

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    Mute Sorcha Ní Shúilleabháin
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    Apr 18th 2022, 2:40 PM

    @Mike Dunne: The science speaks for itself in this case.

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    Mute Derek Anderson
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    Apr 18th 2022, 10:01 AM

    Not happy with those the HSE have already passed over now they are openly putting more women at risk and think they doing a good job.
    Scandal after scandal.

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    Mute James Gorman
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    Apr 19th 2022, 8:30 AM

    @Derek Anderson: try researching before posting Derek cos that’s not true

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    Mute Orela Krawczyk
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    Apr 18th 2022, 9:38 AM

    So that that can’t be responsible for missing something. You’d think they’d want to improve the service, seeing that they have Literally Killed people with their negligence. A Lot can change in 5 yrs so they can just say well Your body changed we didn’t miss anything

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    Mute Rmaybe
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    Apr 18th 2022, 3:05 PM

    @Orela Krawczyk: this is improving the service. It is screening for a virus that could cause changes before they actually happen rather than waiting for the changes to happen and then provide treatment

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    Mute EillieEs
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    Apr 18th 2022, 2:17 PM

    People choosing to be outraged rather than reading the article.

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    Mute Rmaybe
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    Apr 18th 2022, 3:06 PM

    @EillieEs: I suspect plenty have just read the headline without any further reading or listening to their nurse when they’ve gone for their smear

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    Mute Sharon Weldon
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    Apr 18th 2022, 4:18 PM

    I get private smear 100e in between the Cervical check appointments. Please inform all the ladies in your life, it could save a life.

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    Mute Niamh Muireannín
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    Apr 19th 2022, 6:41 AM

    @Sharon Weldon: Did you know, that once you go private and something is found that needs further investigating, you are removed from the HSE process, so won’t be referred for a colposcopy. It isn’t that easy then to have one privately. https://www.irishexaminer.com/news/arid-30943439.html

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