Triage test in cervical screening

What is cervical cancer? 

Cervical cancer is cancer that develops in the cervix. The cervix is the part of the reproductive system that connects the vagina and the womb. Anyone with a cervix can get this type of cancer. It can happen at any age, but it is most common in people aged 30 to 35 years.

What causes cervical cancer? 

Cervical cancer usually develops slowly over time. It is often caused by infection with some types of human papillomavirus (HPV). Most people will be infected with HPV at some point in their life. Usually, it will go away on its own, but for a small number of people it will not. This is known as a ‘persistent infection’. A persistent infection with HPV can cause changes in cervical cells that may turn into cancer if they are not found and treated.

The NHS Cervical Screening Programme  

In the UK, the NHS runs a Cervical Screening Programme. People with a cervix aged between 25 and 64 years are invited every five years for cervical screening. This is to help prevent cervical cancer by finding changes to cervical cells early, rather than testing for cancer itself.

During the appointment, a small sample of cells is taken from the cervix and sent to a laboratory for testing. The sample is first checked for HPV. If HPV is not found, no further tests are needed. The person will be invited for routine screening again in five years. If HPV is found, the sample is checked for abnormal cells. This check is called cytology.

Cytology acts as a ‘triage’ test. Triage tests are used to decide what happens next. If abnormal cells are not found, the person will be invited back in 12 months’ time to check if the HPV infection has cleared. If abnormal cells are found, the person will be offered a different test to look at the cervix. This is called a colposcopy. What happens after this depends on the findings. This might include more tests or treatment. Some people will not need anything to be done after the colposcopy.

What does the UK National Screening Committee recommend? 

The only triage test that the UK NSC recommends for cervical screening is cytology.

What has the UK NSC previously done? 

In 2024, the UK NSC found there were a lot of other studies about other types of triage tests that could be used in the cervical screening programme.

What are we going to do?  

Based on the work in 2024, the UK NSC have asked us to look in detail at the evidence for different tests. This will help them decide if they could recommend other tests for screening. We will look at the evidence for three questions:

1. How good are the tests are at finding changes in the cervix compared to tests used currently?

2. Are these triage tests good value for money compared with current practice?