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What is the right age for cervical screening?

Posted by: , Posted on: - Categories: Health and Wellbeing, Reducing the burden of disease, Screening

Updated 28 January 2019

Cervical screening can be a complicated area to understand – especially for a young woman who has to decide whether or not to attend her first screening appointment.

Even for a woman who has been screened several times it can still be complicated, so she shouldn’t fret if she is struggling to make a decision.

Each screening invite comes with information to help a woman decide whether or not to attend and there’s also plenty of information online too.

So what is cervical screening?

What cervical screening actually does is to highlight abnormalities that, if left, might develop into cancer. So that’s the first thing – it is not a test for cancer.

Furthermore, a cervical screening test result which requests that a woman is called back for further investigation doesn’t usually mean she has cancer.

Women are first invited into the screening programme just before their 25th birthday and will be invited for cervical screening every three years up to the age of 49.

From the ages of 50 to 64 women are invited every five years, at which point they are no longer invited regularly unless they need on-going surveillance or follow up treatment.

1 - cervical leaflet

Lowering the age

We often get asked why the age women are first invited for screening isn’t lower – at the age of 20, say?

The reason for this is that evidence has shown that screening women under the age of 25 can lead to many unnecessary and harmful investigations and treatments.

Cervical cancer is extremely rare in under-25s. At this age women often undergo natural and harmless changes in the cervix that screening would identify as cervical abnormalities.

The problem with screening is it involves putting these women through further tests and investigations they wouldn’t otherwise have gone through when, in most cases, these abnormalities would have sorted themselves out without any need for treatment.

If it was just this worry and no other risks were involved, that would be bad enough, but research has shown if women undergo unnecessary treatment this can have an adverse effect on later pregnancies, with babies possibly being born prematurely.

How do we decide when to start screening women?

We’re advised by experts when it comes to the right age to begin screening.

When the NHS Cervical Screening Programme was established in 1988, women were invited for screening from the age of 20. This decision was largely based on available data at the time.

However in 2003, a group of expert clinicians and scientists, the Advisory Committee on Cervical Screening (ACCS), was asked to review the age from which cervical screening should be offered.

After analysing the available evidence, the committee concluded that the harms of screening women under 25 outweighed the benefits, and advised the programme to raise the starting age for cervical screening from 20 to 25.

This decision was reviewed again in 2009 by the ACCS, who voted unanimously to keep the age at which screening starts at 25. The International Agency for Research on Cancer also recommended the same starting age.

Women experiencing symptoms

Cancer can develop between regular screening tests so it is important for women to look out for anything that is unusual for them, especially the following:

  • Bleeding between periods, or after sex
  • Pain or discomfort during sex
  • Vaginal discharge.

Bleeding after sex is a particularly important symptom to report.

If a woman has any of these symptoms, she needs to see a GP as soon as possible. She should not wait for her next cervical screening appointment.

Usually these symptoms won’t mean a woman has cancer. But if there are any abnormalities, the earlier she can receive the appropriate follow up treatment, the better.

HPV vaccination

Almost all cervical cancers are caused by the human papillomavirus (HPV) – a very common sexually transmitted infection which is linked to the development of the disease.

This is why girls are vaccinated before they become sexually active.

Since 2008, adolescent girls have been offered the vaccine which immunises them against the majority of the high risk strains of HPV that are associated with cervical cancer.

This vaccine will reduce the already low rates of cervical cancer in these young women and mean they will be protected for many years.

The HPV vaccine is delivered largely through secondary schools.

HPV vaccinated women are advised to continue accepting their invitations for cervical screening as the vaccination prevents the most common – but not all – types of cervical cancer.

So, just to emphasise: cervical screening is not a test for cancer. It is primarily a method of preventing cancer through identifying and treating any abnormalities, which, if left untreated, could develop into cancer.

The best preventative measure is for eligible women to attend their routine cervical screening appointment, when invited, and we strongly encourage them to do so.

The NHS Cervical Cancer Screening Programme is delivered by the NHS and coordinated by the national office of the NHS Cancer Screening Programmes, part of Public Health England.

PHE will soon be launching a campaign to encourage women to attend their cervical screening. More to follow on this shortly.

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  1. Comment by Sam Unkim posted on

    The test should be brought forward for patients who become sexually active at a young age, have had multiple partners and are likely to have had unprotected activity.

    I think you would be surprised at the welcome such a message would receive after Jade Goody etc.

    • Replies to Sam Unkim>

      Comment by Anne Mackie posted on

      Unfortunately, as a national screening programme it would not be possible to vary the age of entry into the programme. It’s important to remember that cervical cancer in women under 25 is very rare and evidence has shown that screening women under this age may do more harm than good. If a woman has any symptoms, screening can delay her getting the most appropriate treatment. Therefore, we strongly encourage any woman with symptoms, such as bleeding after intercourse, to speak to her GP straight away.

  2. Comment by Deirdre posted on

    I am pleased to see that you are saying women have a choice in whether to take up their screening invitation, as most women have falsely been led to believe it is mandatory. I don't think PHE is getting the point across that the smear test is very unreliable in young women, and is not good at detecting the adenocarcinoma type of cervical cancer, which is more common in younger women, but is more suited to the squamous cell type which develops over a period of years in older women. Until PHE explains this fact to women, there are going to be endless mis-guided campaigns by mis-informed young women (and politicians), to lower the age, and harm so many women. PHE should come clean about this now.