Health care professionals lack knowledge about cervical screening, study finds

New research led by Keele University into awareness about human papillomavirus (HPV), the main cause of cervical cancer, has found that health care professionals across the UK are not as well informed as they should be.

This week is Cervical Screening Awareness Week which aims to raise awareness about cervical screening and HPV to the general public, but also to health care professionals, including GPs, practice nurses and consultants.

The research, conducted by Dr Sue Sherman from Keele University in conjunction with Jo's Cervical Cancer Trust and published in the European Journal of Public Health, found that a quarter of the 643 health care professionals surveyed thought that HPV always required treatment, when in actual fact it doesn’t, only the cell changes it causes can be treated; close to a quarter were unaware or unclear about how common HPV is; and nearly 7% either thought HPV causes HIV/AIDS or were unsure.

In the UK, women are currently invited to attend cervical screening every three years from the ages of 25 to 49 and every five years from 50 to 64. When a woman attends a screening, a healthcare professional will take a swab of cells from the cervix. With the exception of Wales and a few pilot sites in England, this cell sample is then examined for pre-cancerous changes. In England, if borderline changes are found, then a test for HPV is conducted and if the test is positive the woman is referred for further tests. In Wales, and the pilot sites, the HPV test takes place first, which is a common infection that 80% of sexually active adults will be exposed to in their lifetime.

In the UK, there are around 3,200 new diagnoses and 900 deaths from cervical cancer every year, according to Cancer Research UK, 2017, and between 2011 and 2018 the number of women attending screening had fallen by 4.3%.

Dr Sherman, who specialises in the public awareness and psychological impact of issues surrounding cervical screening and HPV, says the gap in knowledge from healthcare professionals needs to be addressed so misunderstandings are not passed on to the public, causing a further reduction in screening attendance.

Dr Sherman said: "This latest research, conducted in conjunction with Jo's Cervical Cancer Trust, demonstrates that more education is required to enable health care professionals to keep abreast of the changes taking place to the cervical screening programme. HPV is extremely common, with 4 in 5 of us likely to come into contact with it. Unfortunately, in part due to the sexually transmitted nature of the virus, some women can feel embarrassed about testing positive for HPV. As changes to the screening programme are rolled out, well-informed health care professionals can help ensure that this potential for embarrassment doesn't reduce screening attendance further.”

Later this year England will replace cervical screening with HPV testing as the primary screening method for cervical cancer, as HPV is responsible for 99.7% of cervical cancers meaning it rarely develops in the absence of HPV. Scotland will introduce HPV primary testing in 2020 and Northern Ireland has yet to confirm their dates. But Dr Sherman recently published findings from interviews that revealed that due to the sexually transmitted nature of HPV, some women, for example, in long-term relationships would feel uncomfortable being tested for HPV even knowing that this was a test to prevent cervical cancer.

Dr Sherman is also concerned that the change to HPV primary screening might result in more women from some religious and cultural backgrounds opting out of screening.

Robert Music, Chief Executive, Jo’s Cervical Cancer Trust: “With the cervical screening programme moving to testing for HPV first, more women will be told they have HPV. HPV can be confusing however it affects the majority of us so we must increase understanding about it. GPs and health professionals will be having more conversations with patients about HPV as they come in to discuss their results and it is essential that they are equipped to answer questions especially around the day to day impact of having the virus. They must take the lead in ensuring people don’t feel ashamed or scared about being told they have the virus.”