Cervical cancer screening has been associated with a 70% reduction in cervical cancer mortality in developed countries since the introduction of the Papanicolaou (Pap) test in 1941

The main aim of cervical screening is to detect pre-malignant changes rather than to detect cancer.

NOTE: cervical adenocarcinomas, which account for around 15% of cases, are frequently undetected by screening

Who is screened

A smear test is offered to all women between the ages of 25-64 years

• 25-64 years: 5-yearly screening
  • the guidelines changed in July 2025, previously younger women were offered screening every 3 years but the success of HPV testing has extended this period
• cervical screening cannot be offered to women over 64 (unlike breast screening, where patients can self-refer once past screening age)

Special situations

• cervical screening in pregnancy is usually delayed until 3 months post-partum unless missed screening or previous abnormal smears.
• women who have never been sexually active have very low risk of developing cervical cancer therefore they may wish to opt-out of screening

How is it performed

There is currently a move away from traditional Papanicolaou (Pap) smears to liquid-based cytology (LBC). Rather than smearing the sample onto a slide the sample is either rinsed into the preservative fluid or the brush head is simply removed into the sample bottle containing the preservative fluid.

Advantages of LBC includes

• reduced rate of inadequate smears
• increased sensitivity and specificity

It is said that the best time to take a cervical smear is around mid-cycle. Whilst there is limited evidence to support this it is still the current advice given out by the NHS.