What the change to Wales’ cervical cancer screenings really means for women

Written by Rose Sgueglia

As the routine cervical screening interval in Wales is extended from three to five years, Cardiff-based writer Rose Sgueglia examines what this will mean for women like her. 

From slightly annoying to painful, going for a smear test isn’t always the most comfortable procedure. But, when such a simple test can save lives by helping to diagnose cervical cancer, this small task becomes a process most of us undertake gladly and encourage everyone else to do too.

After all, we have always been told that prevention is the most effective weapon we have against any form of cancer.  Cervical cancer is the fourteenth most frequent cancer in women, with around 3,000 people being diagnosed each year in the UK. But, cervical screening prevents around three-quarters of cervical cancers, saving an estimated 5,000 lives each year, according to the NHS Cervical Screening Programme.

In England, all women and people with a cervix aged 25 to 49 are invited to have a cervical cancer smear test every three years. In Wales, as of 1 January 2022, the frequency of cervical cancer screening for this age group was reduced from three to five years if human papillomavirus (HPV) is not found in their cervical screening test. 

A Change.org petition calling for the decision to be reversed has now reached over 1.2 million signatures. But what does this change really mean for women?

The announcement follows a recommendation from the UK National Screening Committee based on the success of the HPV smear testing in Wales. Launched in 2018, the HPV test looks first for high-risk HPV, which is responsible for 98.8% of cervical cancer cases.

According to the Public Health Wales, the HPV test is more effective at identifying people at higher risk of developing cell changes that can cause cervical cancer. It says new evidence shows it is safe to extend the time between cervical screening tests for people who do not have HPV.

“Evidence shows if no high-risk HPV is found in a woman’s sample, the woman has a very low risk of developing cervical cancer within five years, as it takes around 10–15 years to develop after infection with HPV,” says Public Health Wales’ website.

Wales’ Health Minister Eluned Morgan has reiterated this, saying in a statement: “The change has been made because the current screening is more accurate than previous testing and, therefore, less frequent screening is required for those who do not have HPV.”

She says that those who are identified as having HPV “will be followed up closely” and that “the change to the screening interval has been made in line with the independent, expert advice of the UK National Screening Committee”.

Despite the HPV test being introduced in 2018, many campaigners have argued the new changes appear abrupt and not explained at length. Since then, efforts have been made by different organisations, including Jo’s Cervical Cancer Trust, to address and outline the changes, but a sense of frustration and confusion remains.

Despite the overwhelming approval and a public apology from Public Health Wales regarding its poor information campaign, the petition on Change.org has voiced various concerns, including mine.

As someone in her 30s who hasn’t received the HPV vaccine and who has gone through a pretty tough autoimmune disease treatment back in 2018, I am at a higher risk of developing HPV. Yet, no specific information has been offered to people like me. 

I am not the only one concerned about the changes. Other Welsh women also have apprehensions. “I understand the reason they have made the time between screenings longer is that the tests are better, but I can’t help but feel like they are cutting costs,” Laura Poole, 29, from Cardiff Bay tells me. “After all the campaigning that has happened to get women to go to their screenings, cutting back on them makes them feel less important.”

“It gives me reassurance that I’ve been told this decision is based on the fact that HPV accounts for over 90% of cervical cancers in under 45s. Although I’d personally feel better if the screens were every three years not five. All three of my sisters have had abnormal cells and further treatment,” says Anita Mattson-Hesketh, 33, from Cardiff. 

“In 2018 I had a normal result for my cervical smear test. However, eight months later I developed cramping and spotting after sex. I went to my GP and through a further smear test found out I had CIN3 abnormal cells,” says Emma Beaumont, 32, from Swansea. “I had to go through two rounds of treatment including cold coagulation and an LLETZ loop, which was horrible, to fix the problem. I am so scared about the changes.”

Further reservations have also been expressed by members of the medical community. These have highlighted concerns at the possibility of some people picking up HPV in the five-year interval.

“HPV can affect the cervix very quickly in HPV-unvaccinated individuals and even in some who are vaccinated. I think many individuals could slip through the net with the interval being increased to five years,” Dr Belinda Griffiths from Fleet Street Clinic tells Stylist.

“Often individuals seek private cervical smears because they are unable to obtain a smear test earlier than three to five years and they may have symptoms such as postcoital bleeding, intermenstrual bleeding or pain. These symptoms urgently need investigating. In these instances, individuals shouldn’t wait for their next recall date.

Dr Griffiths adds: “The last two years, especially with the pandemic, have created long wait times for individuals who have symptoms, abnormal smears or are undiagnosed HPV-positive. Of course, HPV-positive individuals should be prioritised over HPV-negative individuals as their risk is substantially higher; however, there is still a risk for those who are HPV-negative to go on to develop symptoms or become HPV-positive in the longer interval period.”

As the NHS website advises, anyone experiencing any abnormal symptoms between screenings should seek medical help. Jo’s Cervical Cancer Trust and Vulval Pain Society offer support, while the LGBT Foundation has information about cervical screening for LGBT+ people.

At the moment, as a result of the pandemic, the process for requesting an appointment with a doctor has become particularly taxing in Wales. A report released last year by patients’ watchdog The Community Health Council, found people in some areas of Wales face a “crisis of access” to GPs, with many left waiting for up to an hour on the phone to speak to someone.

In my experience at some GP clinics, a triage system is used; after a brief conversation with someone at reception, you are asked to wait for a GP’s call to discuss further. However, if you miss the call, you have to begin the process all over again which can often feel like an unfortunate deterrent when appointments are already limited.

I’ve also found that it’s quite difficult to speak to the same doctor about a recurring issue in some clinics, and seeing someone in person is strictly dependent on how important the issue is deemed to be.

My concern is that the changes to cervical screening will place further pressure on surgeries and stress on people experiencing symptoms in-between screenings as well as delays in receiving further treatments. 

As positive as the new HPV testing changes can be, it looks like they will need to be supported by an equally strong GP surgery network to cushion the number of people who may or may not experience symptoms between screenings.

During the current pandemic, I’m worried this won’t be the case, and many symptoms and rightful concerns won’t be given the right amount of consideration. 

Responding to my concerns, Dr Sharon Hillier, director of the screening division for Public Health Wales, told Stylist: “This screening interval change is safe.It is based on recommendations from the UK National Screening Committee and has already been implemented in Scotland.99.8 per cent of cervical cancers are caused by HPV. 

“Following this change, people with high-risk HPV will be followed up more closely and more regularly than with the previous method of testing, while women and people with a cervix with no high-risk HPV found will not have to attend cervical screening for five years.It takes around 10 to 15 years to develop cervical cancer after infection with HPV.Attending your smear test when invited is the best way to protect yourself.”  

For more information, help or support about cervical screenings across the UK, you can contact Jo’s Cervical Cancer Trust by joining the Jo’s Cervical Cancer Trust Forum or calling its helpline.

The Government website has a guide to cervical screening. Or, visit the NHS website for further useful resources.  

Images: Getty

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