Mythbuster: ‘I don’t need a smear test – I’ve had my HPV jab’

Nurse specialist in sexual health Jodie Crossman explains how to overcome potential misconceptions around the need for cervical screening among women vaccinated against HPV

Since the introduction of the successful Human Papillomavirus (HPV) vaccination programme, many nurses may have heard the argument: ‘I don’t need a smear test – I’ve had my HPV vaccination.’

On the surface, it may sound logical. HPV vaccination is designed to protect women against the primary cause of cervical cancer, so why would they still need to undergo smear tests?

Like many health myths, this stems from a grain of truth. The HPV vaccination programme has significantly reduced cervical cancer incidence in the UK ,¹ and discussions about adjusting the frequency of smear tests are ongoing.²

However, we are by no means at a point where we can end routine cervical screening.

What’s the reality?

The HPV vaccine is one of the most successful cancer prevention tools we have. In the UK, it has been routinely offered to girls (since 2008) and boys (since 2019) aged 12–13.³ To encourage uptake, public messaging has (rightly) focused on how effective the vaccine is.

However, this overlooks some crucial details. Firstly, the vaccine doesn’t protect against all high-risk HPV types.⁴ The earlier vaccines (bivalent and quadrivalent) target HPV 16 and 18, which are responsible for around 70% of cervical cancers. The newer 9-valent vaccine covers more strains, but still not all. So although overall risk is dramatically reduced, even vaccinated individuals can still be at risk of other cancer-causing HPV types.³

Timing also matters. The vaccine is most effective when given before someone becomes sexually active. For those vaccinated later, or who missed doses, protection may be reduced.⁵

There’s also some confusion around what ‘fully protected’ means. Some people assume vaccination guarantees full immunity. But vaccine effectiveness ranges from 12% to 93%, depending on age at administration and immune response. Not everyone achieves the same level of protection.⁵

Why might this be a problem?

Cervical screening rates in the UK are declining, especially among younger people.⁶ While multiple factors contribute – including anxiety about the procedure and access issues – the idea that vaccination removes the need for screening may also influence behaviour.⁷

How can we address it?

It’s essential to be clear: people with a cervix still need regular cervical screening – even if they’re vaccinated.

The NHS cervical screening programme recommends screening from age 25, every 3 years until age 50, then every 5 years until age 64. The test now checks for high-risk HPV first and only examines cells for abnormalities if HPV is detected – making it more targeted and effective.⁸

Vaccination lowers the risk but doesn’t eliminate it. Screening remains vital to catch early changes before they develop into cancer.

How to discuss this with patients (and colleagues)

It’s important to be empathetic. If someone says ‘I’m vaccinated, so I don’t need a smear’, acknowledge the positive first by saying something like ‘That’s great, you’ve already taken a big step in protecting your health’.

You can then move on to gently clarify the need for continued smear testing. For example: ‘The vaccine protects us really well against some types of HPV, but not all. Screening helps us to catch any changes early – even if caused by another type of HPV.’

It can sometimes help to use analogies. One might be: ‘Wearing a seatbelt doesn’t mean there is no need for airbags. Both work together to keep you safe.’ In the same way, vaccination and screening are two parts of the same prevention strategy.

Talk to the patient about why they may be reluctant to have a cervical smear. There may be options to reduce pain and discomfort. Offer a double appointment if previous smear tests have been difficult. Make sure patients receive timely invitations and reminders, and that booking is as straightforward as possible and offers a range of times. Ensure also that trans men are aware they will not be routinely called for smear testing if they are registered as male with the GP.

With colleagues, it is important to use meetings or any educational sessions or materials to reinforce that vaccination doesn’t remove the need for screening. Everyone in the team should be equipped to share accurate, consistent messages.

Embedding good practice

To tackle any misconceptions effectively, it is important to integrate clear, consistent messaging in everyday practice:

Include HPV education in consultations.
Reinforce screening in all health communications.
Use every opportunity to promote both vaccination and screening.

The HPV vaccine is a powerful tool but it’s not a substitute for cervical screening. As nurses, we can help ensure that patients understand both are important to prevent cervical cancer.

Jodie Crossman is clinical nurse specialist in Genitourinary Medicine at Brighton Sexual Health and Contraception service, and Co-chair of the STI Foundation

References

Falcaro M, Soldan K, Ndlela B et al. Effect of the HPV vaccination programme on incidence of cervical cancer and grade 3 cervical intraepithelial neoplasia by socioeconomic deprivation in England: population based observational study. BMJ 2024;385(385):e077341
Landy R, Windridge P, Gillman M et al. What cervical screening is appropriate for women who have been vaccinated against high risk HPV? A simulation study. Int J Cancer 2017;142(4):709-18
UK Health Security Agency. HPV universal vaccination: guidance for health professionals. 2023
National Cancer Institute. HPV and Cancer. 31 January 2025
Ellingson M, Sheikha H, Nyhan K et al. Human papillomavirus vaccine effectiveness by age at vaccination: A systematic review. Hum Vaccin Immunother 2023;19(2):2239085
NHS England. NHS makes fresh uptake appeal as five million women not up to date with cervical screening. 28 November 2024
Henderson L, Clements A, Damery S et al. ‘A False Sense of Security’? Understanding the role of the HPV vaccine on future cervical screening behaviour: A qualitative study of UK parents and girls of vaccination age. J Med Screen 2011 Mar;18(1):41-5
Public Health England. Cervical screening: programme overview. 17 March 2024