Vaccines could mean only one smear test a lifetime

People who have the HPV vaccine may need only one smear test to prevent cervical cancer in their lifetime, according to a leading scientist.

Women and people with a cervix are currently invited for screening every three to five years in the UK.

Prof Peter Sasieni said the vaccine was leading to such dramatic reductions in cancer that the screening programme would need to change soon.

Cancer Research UK urged people to still come for screening when invited.

Nearly all cases of cervical cancer are caused by human papillomaviruses - known as HPV. They can damage DNA and start to transform healthy cells into cancerous ones if there is a prolonged infection.

There are more than 100 types of human papillomavirus and they are so common that most people will get an infection at some point during their lives.

So women, and people with a cervix, are invited for regular screening. Swabs of the cervix are used to check for signs of abnormalities using a microscope (the traditional smear test) or more recently to test for the virus itself.

However, a seismic shift in preventing cervical cancer started in the UK in 2008 with the introduction of the HPV vaccine. It is offered to girls (and boys since 2019) aged between 11 and 13.

The viruses are spread by close skin-to-skin contact so the vaccine is given before school children become sexually active.

Research published in December shows the vaccine is cutting cervical cancer by nearly 90% in those who choose to have the jab.

"This is really exciting," Prof Sasieni, the director of the clinical trials unit at King's College London, told Inside Health on BBC Radio 4.

His modelling suggests between one and three checks a lifetime would be appropriate for people who have been immunised.

He told me: "Probably women could be screened at [age] 30 and 45, you might want to do it at 30, 40 and 55 so three times.

"There's a new vaccine which will be used in the UK from the next school year, which protects against even more types of the virus, and I think with that probably one screen would be enough, maybe two, over a lifetime."

That would mark a dramatic shift in cervical screening in the space of a generation with mums needing regular checks while their daughters would need to go only a handful of times.

However, the UK National Screening Committee has not made a decision about the future of cervical screening.

Prof Sasieni says the issue is becoming increasingly pressing as the first generation to be vaccinated are now being invited for screening.

"We really want to make those changes over the next couple of years, it is a big change [but] the vaccine has been so successful this makes perfect sense," said Prof Sasieni.

Laura Flaherty was diagnosed with cervical cancer this year at the age of 29 after putting off a routine smear test.

"The HPV vaccine hadn't been rolled out when I was at school," she says.

"I was diagnosed after a routine smear test. I'd put it off for four months - and while it wouldn't have made a difference to my diagnosis - it just shows how important it is to keep up to date with your smears.

"I was told I had abnormal cells and tested positive for HPV and further investigation revealed I had stage one cervical cancer, which resulted in a hysterectomy.

"I was sat in a room and told: 'I'm really sorry, it's cancer'. I had two small children and I said 'I need you to save me, they need looking after'.

"I went for my smear test in February this year and was given the all clear in August. I just always feel so lucky to be here."

There are uncertainties. It is not known how long the protection from HPV lasts or if a mid-life booster dose is needed. And regular screening will be needed for decades due to the generations that have not been immunised.

Karis Betts, the health information manager at Cancer Research UK, said: "Although we don't know exactly what cervical screening will look like in the future, we're already seeing scientific advances shape the way it's delivered in the UK.

"The success of the HPV vaccination programme and the introduction of better tests mean people need fewer screenings, but are still just as protected against cervical cancer.

"Regular screening plays an important role in preventing cancer, especially if you have not received your HPV jab."

The Department of Health and Social Care said one in three people do not come for screening when invited.

A spokesperson added: "The NHS Cervical Screening programme remains an important way of protecting the population - including those who have not been vaccinated - from developing cervical cancer."