🧭 When to offer screening (and when to suspect cancer)

Cervical screening is a preventative test for asymptomatic people with a cervix – it is not a test for cancer. It works by detecting high-risk human papillomavirus (hrHPV), the virus responsible for around 99.7% of cervical cancers, and then – only where hrHPV is found – checking the same sample for the cell changes (dyskaryosis) that can precede cancer, so they can be treated long before they ever become malignant.

Since December 2019, England has used HPV-primary screening: the sample is tested for hrHPV first, with cytology performed only if hrHPV is positive (reflex testing). Because a negative hrHPV result has a very high negative predictive value, those who test negative are at very low risk for many years – which is why screening intervals have been safely lengthened to five years.

The key skill in primary care is twofold: run the result-driven recall and referral algorithm correctly, and remember that screening is for the asymptomatic. A patient who is symptomatic needs clinical assessment and, where appropriate, an urgent cancer-pathway referral – not a routine smear slotted into the recall cycle.

Who	Screening offer
Under 25	Not invited – screening under 25 does more harm than good
25–64, hrHPV negative	Routine recall every 5 years (England, from 1 July 2025; ages 50–64 were already 5-yearly)
Recent hrHPV positive, not yet cleared	3-yearly surveillance until hrHPV negative, then moves to 5-yearly
65 and over	Not routinely invited – offered only if a recent test was abnormal, never screened, or not screened since age 50 (can self-request)
Living with HIV	Annual screening

First invitation is sent at 24.5 years so the first test can happen by 25. Anyone with a cervix is eligible regardless of gender identity; trans men and non-binary people registered as female are invited automatically, while those not registered female must opt in to recall.

Source: NHS Cervical Screening Programme · UK National Screening Committee

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