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HPV Awareness Day Press Release

CervicalCheck and Primary HPV testing, common questions answered

To mark International HPV Awareness Day today, (Friday, 4th  March 2022), CervicalCheck is answering some of the most commonly asked questions about its cervical screening test, HPV cervical screening, and is releasing the latest in a series of information videos which explain what happens during screening in different languages.

In 2020 CervicalCheck changed how it screens women and people with a cervix for cervical cancer. This move, from primary cytology screening (smear test) to primary HPV screening, was recommended by a Health Information and Quality Authority (HIQA) Health Technology Assessment report.

The report focused on the fact that cervical screening is not a test for cancer but is instead a test to identify those at increased risk. Human papillomavirus (HPV) is a virus that can lead to cell changes that, if left unchecked, can lead to cancer.

Testing for a virus
While the screening test women have at their GP surgery or clinic has remained unchanged, how the sample is tested has changed. Where the sample taken from the woman’s cervix would previously have been looked at under a microscope for abnormal cell changes by at least two specialist screeners, it is now tested by machine for the presence of HPV.

HPV cervical screening is a more sensitive cervical screening test which looks for high-risk types of HPV that cause 92 % of cervical cancers. This test helps to prevent more cancers than the previous primary cytology testing as it identifies more people who are at risk of cervical cancer. This allows changes to be found and treated at an earlier stage.

Time between screening
The time between tests has also changed. If a person is aged 25 to 29 they will usually have a cervical screening test every 3 years. If a person is aged 30 to 65 they will now usually have a cervical screening test every 5 years. Those who are identified as having HPV will be followed up closely.

The change to the time between screens has been made because the current screening test is more accurate than previous testing and, therefore, less frequent screening is required for those who do not have HPV.

In most cases, it takes 10-15 years for a HPV infection to develop into cervical cancer. Cervical cancer is a rare outcome of a HPV infection. It is safe to wait for 5 years between tests if people do not have a HPV infection.

Dr Nóirín Russell, Clinical Director CervicalCheck, said: “Evidence shows that primary HPV is a better test. Studies have found that screening for HPV first, followed by cytology, in those that screen positive for HPV, will detect 90% of women at risk of cervical cancer. This is significantly better than a cytology-first test, which detects 75% of women at risk. It also means that we can increase the gap between screening tests to five years for women over a certain age.

“Understandably, women, especially those who would previously have been screened every three years, may have questions about why we have made this change. We’re keen to address any concerns and to show how the move to primary HPV screening will improve screening for them.”

 

Primary HPV Screening – what you need to know

What happens if you find HPV in my test sample?
If HPV is found, the same sample will be looked at by a minimum of two specialist screeners, for abnormal cells. In some cases, your sample may also be reviewed by a pathologist. If we find HPV and no evidence of abnormal cell changes we will call you back for a test in 12 months to see if the virus is still present.

If HPV is not found, you will be called back for your next test in either 3 or 5 years (or sooner, depending on your personal screening history). If HPV is not found we do not need to check your cells in cytology as the risk for developing abnormal cells that could lead to cancer is very low.

Why do you screen for HPV first?
A test showing that you do not have a HPV infection is more reliable than a test finding normal cells.

Cervical screening aims to prevent the most common form of cervical cancer – which is squamous cell cancer – and 99% of those cancers are caused by 14 high-risk types of HPV. Two of these high-risk types cause 7 out of 10 cervical cancers.

This means that if you don’t have these types of HPV detected in your sample, it is extremely unlikely you have any cell changes that need treatment.

How can HPV testing be better than looking at my sample?
The evidence so far suggests screening for HPV will find more precancerous changes. In 2017, a review of 40 studies* concluded that if 20 women out of 1,000 had precancerous changes, primary HPV screening would correctly identify 18 of these women, whereas primary cytology screening would only identify 15 of these women.

I’m a lesbian woman – am I at risk of HPV?
Anyone who has been sexually active is at risk of HPV. It’s a very common group of viruses that you can get from any kind of physical or sexual contact of the genital area, not just penetrative sex.

Sexual contact includes:

  • any skin-to-skin contact of the genital area
  • vaginal, oral or anal sex
  • sharing sex toys

There are usually no symptoms of HPV, so you could have a HPV infection and not know it.

What if I have had HPV and cleared the infection before I get my screening test?
There are over 100 different types of HPV. Most people will get some type of HPV during their lives.

For most people, the virus goes away on its own and doesn't cause any harm.

Your risk of developing cell changes is very low while you do not have HPV infection. In most people, the body clears HPV infection on its own, within 18 months. But sometimes, the infection doesn’t go away. Chronic, or long-lasting infection, especially when it’s caused by certain high-risk HPV types, can cause cancer over time.

If I don’t have HPV can I still develop cervical cancer?
Unfortunately, in very rare cases, yes, but coming for screening when invited is an important way to reduce that risk as it allows us to build a picture of your health over time. There are rare types of cervical cancer that cannot be detected in screening – for example they are located in an area we are not able to reach in screening or are not caused by HPV. Other cancers can develop between screening, we call these cancers interval cancers. That’s why being aware of the symptoms of cervical cancer is so important. Other things that put you at risk of cervical cancer include smoking and if your immune system is weaker making you more susceptible to infections.

Previously, I had abnormal cells detected. Under the new test, is it possible that these abnormal cells will go undetected?
Testing for active HPV infection gives us a very good indication of your level of risk of developing abnormal cells and whether your sample should be tested further.

If the cytology test then finds abnormal cells and recommends further investigation, that is done in the colposcopy clinics. It’s here that treatment will be offered if needed. You will then be recalled for screening at an interval that is dependent on your own personal screening history.

Only a very small number of women who are found to have abnormal cells will go on to develop cancer. In Ireland approximately 6,000 women per annum will have abnormal cells identified and treated and, because of this, most will never develop cancer.

I got the screening all-clear two months ago now I’m having symptoms including bleeding after intercourse, should I come back to screening?
If you are experiencing symptoms please visit your GP. Screening is for well women and works by identifying healthy people who may have an increased chance of having a disease or condition, enabling effective early treatment. You should contact your GP to discuss symptoms as soon as possible.

My next screening appointment isn’t for five years but I’m sexually active – what if I catch HPV between now and then?
HPV is a very common infection, most people will get it during their lifetime. Having HPV doesn’t mean you will develop cervical cancer – it’s a rare outcome of persistent, active infection. If you do have one of the high-risk types of HPV it takes between 10 and 15 years for cancer to develop.

My last test was really uncomfortable and now I’m in menopause it will be worse. Can you help?
Yes, there are many ways your sample taker can make the screening test more comfortable for you depending upon your circumstances. These can include using a smaller speculum (the instrument that is used to help the sample taker open your vagina), a different type of lubricant suited to thinner menopausal skin, and perhaps even a course of vaginal oestrogen taken prior to the test. We would encourage women to raise any concerns about the test with their GP or practice nurse who can discuss the options available.

I went for my test and got the all-clear. Why do I have to wait five years?
If HPV is not found in your sample, we know you are very unlikely to have abnormal cells. Cell changes may occur during this time but they are extremely unlikely to develop into cancer if HPV is not present. Because the HPV cervical screening test offers greater protection against the development of high grade pre-cancerous changes, it allows a greater interval (time) between tests.

Studies have shown that a negative HPV test has twice the protection against having high-grade changes at six years than a negative cytology test has at three years

This allows the time between screenings to be increased without decreasing protection at population level, and also reduces the amount of unnecessary tests for a woman in her lifetime. The recommendations regarding our new intervals came from a detailed piece of work completed by HIQA HTA, published in 2017, and is based on research, evidence and international best practice. Screening at five year intervals is also the current evidence-based recommendation for screening in the UK. It was implemented in Scotland in March 2020 and in Wales in 2022. Screening is done at five-year intervals in other international programmes which provide the HPV cervical screening test, such as Australia and Netherlands.

I wasn’t comfortable attending my last appointment due to Covid-19, now that the restrictions have eased can I make a new one?
You can check if your CervicalCheck appointment is due online and update your details here, or by Freephone 1800 45 55 45. All appointments are free. As our appointments take place in a healthcare setting, for example your GP surgery, you will still be asked to wear a mask and should check with them about any other measures in place.

 

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