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Cervical screening

Research at The University of Manchester has had a major impact on cervical screening policy and practice in the UK and influenced thinking internationally.

Over 70% of cervical cancers are attributed to two types of HPV (human papillomavirus).

Two major randomised trials, funded by the Department of Health and conducted by Professors Henry Kitchener, Graham Dunn and Chris Roberts, evaluated two technologies which had the potential to improve cervical screening.

The first, A Randomised Trial of HPV Testing in Primary Cervical Screening (ARTISTIC), involved over 24,000 women in the Greater Manchester area aged 20-64 who attended their GP practice between 2001 and 2003 for a cervical smear and agreed to be tested for HPV.

The trials team found links between HPV infection rates, the women's age and the number of abnormal cervical cells found. The results showed that about 9 out of 10 women with severe cell changes ('severe dyskaryosis') had HPV.

As a result of the ARTISTIC trial, the UK National Screening Committee agreed that there was enough evidence to suggest that HPV TaPS (Testing as Primary Screening) for cervical cancer would be cost and clinically effective. This led to the establishment of a large HPV primary screening pilot study in 2013.

This was followed by the MAVARIC trial, involving 75,000 samples from women in Greater Manchester aged 25-64 who had a cervical smear between 2006 and 2009. This led to the decision that automated reading of cervical smears in England should not be adopted, as it was shown to be less sensitive than manual reading.

In addition to these two clinical trials, a cohort study on the use of HPV testing to determine cure after treatment for cervical pre-cancer has had significant impact.

Testing to confirm the absence of HPV now means that HPV negative women have returned to three year recall for a re-screen instead of annual check-ups. Further investigation and resource can therefore be concentrated on HPV positive women.

The National Screening Programme for cervical cancer adopted this treatment as a national standard in September 2012.

“A key finding was that after three screen rounds it was clear that a negative HPV test was as protective over six years as a negative smear test was over three years.”

Henry Kitchener / Professor of Gynaecological Oncology