Cervical screening is offered to women aged between 25 and 64 to help prevent cervical cancer. The screening test or smear test, detects early pre-cancerous changes in cells that line the cervix. Most changes are caused by persistent infection with high risk types of the human papillomavirus (HPV).
Northern Ireland Cervical Screening Programme
The cervical screening programme is for women who have no symptoms of disease.
All women registered with a GP in Northern Ireland who fall within the screening age range are automatically invited to go for a screening test.
Women aged between 25 and 49 are invited every three years and women aged between 50 and 64 are invited every five years.
Make sure your GP has your correct name and address so you receive your invitation for screening.
Cervical screening checks a sample of cells from your cervix for certain types of human papillomavirus (HPV).
These types of HPV can cause abnormal changes to the cells in your cervix and are referred to as ‘high risk HPV’.
If high risk HPV is detected during screening, the sample of cells will also be checked for abnormal cell changes under a microscope.
If abnormal cells are found, they can be treated so they do not get a chance to turn into cervical cancer.
Further information about HPV can be found at:
How reliable is cervical screening
Most types of cervical cancer take a long time to develop. By finding cell changes early, screening can help prevent cervical cancer from developing.
Screening will pick up most changes in the cervix but can’t find them all.
Cervical screening is not for anyone with cervical cancer symptoms.
It is also not a test for cancer, although occasionally cancer can be found.
If you have any of the cervical cancer symptoms below, contact your GP practice for an appointment, do not wait until your next cervical screening invite or appointment.
Cervical cancer symptoms may include:
- bleeding between periods, during or after sex or after the menopause (after your periods have stopped)
- unusual vaginal discharge
- pain during sex, or lower tummy or back pain
Changes can also happen between tests so you should contact your GP if you are concerned about symptoms at any time.
How to book cervical screening
You will be sent an invitation letter in the post when it is time to book your cervical screening appointment.
Most cervical screening is done in a GP surgery.
If you would like to be seen by a female health professional, you can ask when booking your appointment.
Call your GP practice to book an appointment with them.
What happens at a screening appointment
The appointment will take about 10 minutes. The cervical screening test itself only takes a couple of minutes and is carried out in a private room, normally by a nurse.
You will be asked to take off your clothes from the waist down, or just your underwear if you are wearing a loose skirt.
You will lie on a bed with your knees bent and your legs open. Your lower body will be covered with a sheet.
The nurse will gently put a speculum into your vagina so they can see your cervix. They will then gently brush cells from the cervix, usually with a soft brush.
The sample is then sent to a laboratory for testing. The person taking your test will tell you when, how and where to get your results.
Cervical screening results
Your result will be sent to your doctor when the lab report is complete.
All samples will have an HPV result and samples that are HPV positive will also have a cytology (microscope examination) result.
This can take on average up to 12 weeks.
Most people will not have HPV.
This means your risk of getting cervical cancer is very low.
You do not need any further tests to check for abnormal cell changes in your cervix, even if you have had these in the past.
You will be invited for screening again in three or five years.
High risk HPV
If you have high risk HPV, your sample will also be checked for abnormal cells under a microscope.
If no abnormal cell changes are found you will be invited for another test in 12 months’ time.
If you continue to test positive for HPV for the duration of three annual cervical screening tests, you will be invited for further tests to check your cervix, even if you have no cell changes (colposcopy).
If you have high risk HPV and abnormal cell changes are found you will be referred to a specialist clinic at the hospital for a test called colposcopy.
Colposcopy is a closer examination of your cervix.
A screening result showing changes in the cells does not mean you have cervical cancer.
Sometimes there are not enough cells in the sample to get a reliable HPV result. If this happens you will be asked to return for a repeat test in three months’ time.
A colposcopy is an examination of the cervix with a type of magnifying glass.
It lets the doctor or nurse look more closely at the changes on the cervix to decide if treatment is needed.
The examination is similar to the screening test and takes about 15 minutes.
You should allow up to an hour for the whole visit.
This will include consultation with the colposcopist about the procedure and a nurse will be present to assist you during the examination.
A small sample of tissue (biopsy) may be taken from an area of the cervix during the procedure. This may be uncomfortable but shouldn’t be painful.
The colposcopist will explain if you need any treatment. Sometimes this can be done at the time of your colposcopy, or you may be asked to come back when the results of the biopsy are available.
The treatment is usually simple and can be done under local anaesthetic.
The choice of treatment will depend on your case.
Follow-up after treatment
Around six months after treatment, you will usually be offered another screening test to check your treatment has been successful. This test will be carried out at the hospital clinic.
Although one in five women are invited back for another colposcopy, only a few will need further treatment. This is because it can take longer than six months for your immune system to clear HPV after treatment.
Your hospital team will keep you under review until they think you can safely return to routine screening tests.
What happens to your sample and data
If the lab has looked at your sample down a microscope, this slide will be kept by the lab for 10 years.
Staff working for the screening programme may see and review your records as a way to monitor and improve the quality of the screening programme and the expertise of the specialist staff.
Any information about you will stay strictly confidential.
If you are diagnosed with cervical cancer, your previous screening history and results will be reviewed.
You will be able to see the results of this review if you wish.
Cervical screening in the Southern Trust laboratory
The Southern Health and Social Care Trust provides a Cervical Cytology Service as part of the Northern Ireland Cervical Screening Programme.
In July 2022, senior laboratory staff told the trust’s management team that they had concerns about performance in some steps of their laboratory’s screening system.
To fully investigate these concerns, the trust commissioned the Royal College of Pathologists (RCPath Consulting) to carry out an independent assessment of its cervical screening services from 1 January 2008 and October 2021.
As a precautionary measure, the trust is carrying out a review of the results of some patients who had cervical smears analysed by the trust during this time period.
Further information is available at:
Cervical screening - addressing the backlog
There are a considerable number of cervical screening samples which are in a cytology backlog due to capacity constraints within the laboratories.
These samples have already tested negative for High Risk HPV (HrHPV), meaning that the risk of having cell changes that could develop into cancer is very low.
Laboratories are now applying the new Primary HPV pathway to samples in the backlog. The samples that have tested negative for HrHPV do not need further testing and the result will be issued to the woman’s GP.
Over 99.7 per cent of cervical cancers are associated with persistent infection with HPV, so screening using HPV testing first is a more effective way of identifying those women who require further follow up.
Since 11 December 2023, all samples received have been processed under the new Primary HPV pathway, resulting in a significant improvement in how quickly women receive their results.
By moving the backlog cases to Primary HPV, all samples in Northern Ireland will be tested using the same pathway and the time taken to communicate results will be improved.