Cervical Cancer

🔍 When to Suspect

Persistent, unexplained abnormal vaginal bleeding (intermenstrual, post-coital, postmenopausal), persistent vaginal discharge, or pelvic pain

From the full topic in The Ocean Library: Cervical Cancer

🧭 When to suspect (and the role of screening)

Cervical cancer arises almost exclusively from persistent high-risk HPV infection, which drives a slow progression through cervical intraepithelial neoplasia (CIN) over many years. That long, treatable pre-invasive window is the entire rationale for screening. The clinical task in primary care splits cleanly in two: in the asymptomatic woman, ensure she is engaged with the screening programme; in the symptomatic woman, examine the cervix and refer on its appearance – a recent or normal smear does not change that.

Suspect cervical cancer in anyone with persistent, unexplained abnormal vaginal bleeding – intermenstrual, post-coital, or postmenopausal – or with persistent unexplained vaginal discharge (especially blood-stained), or a cervix that looks abnormal on speculum examination. Index of suspicion should rise further with a history of lapsed screening, previous abnormal cytology or CIN, immunosuppression, or smoking.

Eligibility	Screening offer
Women and people with a cervix, aged 25–64	Cervical screening using a primary high-risk HPV test, with reflex cytology if HPV is detected.
First invitation	Sent at around age 24.5 so screening can begin by 25.
HPV-negative result	Routine recall every 5 years at all ages (England, since 1 July 2025 – previously 3-yearly for ages 25–49).
Recent HPV-positive history	Earlier recall (3 years) until HPV clears, then the 5-year interval resumes.
Symptomatic at any age	Screening does not apply – examine the cervix and refer on findings, regardless of smear history.

Source: NICE NG12 · NHS Cervical Screening Programme

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