SIP 7: Progress in Cervical Cancer Prevention in the UK (2025 Second Edition).

Cervical cancer remains a preventable yet significant healthcare problem for women globally. The World Health Organization (WHO) announced a call to eliminate cervical cancer in 2018, with recommendations for screening, vaccination, and treatment of precancerous cervical lesions. Screening uptake is on the decline in the UK, particularly for younger women, where the rate has now dropped below 70%. Primary screening is now performed with high-risk human papillomavirus (hrHPV) testing. This test is sensitive, but not specific, meaning it is good at not missing cancers or precancer, but most people who test hrHPV positive will not have cervical cancer or precancer, and therefore testing positive can lead to unnecessary worry. Any samples that test positive for the virus undergo 'reflex' cytology (the process by which cells suspended in liquid are stained and examined under the microscope by those trained to perform this assessment). This means only virus-positive samples are tested to select patients for colposcopy (visualisation of the cervix with special lenses, in a specialist gynaecology clinic). Other possibilities for this triage test, which may improve the accuracy of screening, are currently under investigation and include methylation (a chemical change in DNA that can be measured) testing, and testing for specific markers. HPV type 16 is the most common high-risk strain found globally, including in the UK. The UK national vaccination programme was started in 2008, and uptake in the UK is currently around 80%. Since 2021, Gardasil9 (offering protection against seven hrHPV types and two HPV types that cause genital warts) has been offered to both boys and girls, at school, aged 12-13. In 2023, new guidance from the Joint Committee on Vaccination and Immunisation (JCVI) recommended a single dose as sufficient. HPV vaccination has almost eliminated cervical cancer in those born in or after 1995. Future directions for the screening programme in the UK include self-sampling, adaptations in the post-vaccine era, and increasing the upper age limit of screening. Self-sampling has been shown to be similarly accurate to clinician-taken samples, and may be a good option for those who do not attend for screening, who have been shown to have increased risk of cervical cancer and worse outcomes. One in ten women with cervical cancer in the UK is diagnosed over the age of 75. Globally, recommendations for cervical screening exist in 139/202 countries. Of these, 48 currently recommend hrHPV testing. Efforts must be made to encourage uptake of both screening and vaccination in order to continue to reduce rates of cervical cancer in the UK.