Despite the availability of NHS cervical screening programmes, nearly 1 in 3 women missed their smear test in 2024. To understand why, and how serious this issue is, we analysed NHS England's cervical screening data to reveal the reality behind attendance rates.
As medical negligence experts, we've seen the devastating consequences of delayed diagnoses first-hand and we're committed to getting more women tested to help prevent future cancer cases.
Our Face Your Smears campaign aims to educate, break the stigma, and tackle misconceptions around cervical screening. Why? Because early detection saves lives.
Cervical screening attendance rates across the UK remain worryingly low
Between 2023 and 2024, the NHS invited 5.12 million individuals aged 25–64 for screening—an increase from 4.62 million the previous year. Despite the rise in invitations, only 3.25 million individuals were tested, representing a 5.3% decrease compared to the 3.43 million tested the previous year.
Cervical screening attendance in the UK continues to fall short of acceptable levels, posing significant risks to women's health. The NHS cervical screening programme sets an "acceptable performance" which is defined as achieving coverage levels of 80% or more of eligible individuals aged 25–64. However, in 2024, only 68.8% of eligible women were screened, a decline from 72.4% in 2014. This means 31.2% of people with a cervix missed this vital test, equating to approximately 1,597,440 patients.
This raises serious concerns about late diagnoses and delayed detection—factors that can lead to more aggressive treatments and worse outcomes if cervical cancer is caught too late.
Younger people are less likely to attend their smear test despite heightened risks of high-grade abnormalities
Our analysis reveals that younger individuals, particularly those aged 25–29, who are the first group eligible for NHS cervical screening, are the least likely to attend their appointments. In 2024, only 55.5% of eligible individuals with cervixes in this age group attended their screening – a worrying decrease of 0.9% from 2023. This represents the largest drop in attendance across all age groups.
Similarly, attendance among individuals aged 30–34 was low, with only 64.7% attending 2024. While this represents a slight increase of 0.1% compared to 2023, it remains concerning given the elevated risks in this age group.
Our analysis of NHS data shows that people aged 30–34 had the highest percentage (1.4%) of tests detecting high-grade abnormalities in 2023–24. Younger individuals aged 25–29 (1.1%) and those aged 35–39 (1.2%) also had significantly higher rates of abnormalities compared to older age groups. As medical negligence experts, we've seen the devastating impact of late diagnoses and delayed treatment many times before, and this is something we don't want to see happen to these younger patients.
In contrast, older people with a cervix demonstrated much higher attendance rates. The age group 50–54 recorded the highest screening attendance at 76.2% in 2024, a slight decrease from 76.7% in 2023. Women aged 45–49 followed, with attendance rates increasing from 71.1% in 2023 to 72.1% in 2024—the largest year-on-year improvement across all age groups.
Which areas of the UK are most likely to skip their smear test?
In 2024, the areas with the highest cervical screening attendance were East Riding of Yorkshire (77.8%), Derbyshire (77.1%), and North Yorkshire (77%), while the lowest attendance was recorded in Luton (56.8%), Leicester (57.6%), and Brent (57.9%).
A comparison with 2014 data reveals how attendance rates have shifted over the last decade. In 2014, the highest attendance rates were in Nottinghamshire (79.7%), North East Lincolnshire (79.6%), and East Riding of Yorkshire (79.5%). The lowest rates that year were in Brent (68.6%), Leicester (68.7%), and Barnet (68.8%).
Our 2024 analysis highlights significant declines in coverage in all regional areas since 2014. Nottingham experienced the sharpest drop, with attendance falling from 74% in 2014 to 60.5% in 2024, a decrease of 13.5%. Similarly, Luton's attendance declined from 69.2% to 56.8% (-12.4%), and Leicester's rates fell from 68.7% to 57.6% (-11.1%). Surrey, Wirral, and Thurrock experienced the smallest decreases in attendance, all with drops of 0.8% since 2014.
How many women attend their referrals post-cervical screening?
Between 2023 and 2024, there were 251,251 referrals to colposcopy, marking a 1.8% increase from the previous year's 246,762 referrals. Of these, 63.3% were triggered by abnormal or inadequate cytology results from cervical screening, a slight decrease from 64.9% in 2022-23.
Despite the volume of referrals, only 71.8% of patients attended their appointments in 2023-2024, down from 73.4% the previous year. This means 28.2% (nearly one in three patients) did not attend.
Our analysis found that 13.8% of referrals were cancelled in advance by patients and that clinic cancellations also increased, rising to 6.3% in 2023-2024 from 4.8% in 2022-2023. Additionally, 2.1% of patients cancelled on the day of the appointment, while 5.8% (approximately 14,573 individuals) failed to attend without providing any advance notice.
What do women fear most about their cervical screening?
We don't want women to wait until it's too late. Delays in screening lead to missed opportunities for early detection, making treatment more complex and outcomes far worse.
To help combat this, we surveyed over 100 women to understand the barriers preventing them from attending their cervical screening. Alarmingly, only 1 in 10 (10.3%) reported having no concerns about the procedure.
The most common fear, cited by 61.7% of participants, was pain or discomfort. Many women worried that the procedure would be too painful or recalled previous negative experiences. One participant shared, "older generations perpetuated that it was going to be traumatic", another said, "after menopause it is just too painful to have a smear."
The second and third most common concerns were tied, being reported by 35.5% of women. These included being worried about feeling exposed and being worried about the screening's results. One individual said, "It's quite a private area that is being looked at by an unfamiliar person, which I find intimidating and embarrassing." Another added, "The first time, I was conscious of feeling exposed as nobody ever really had seen me naked like that."
Regarding worrying about the results, one person explained, "Health anxiety can be crippling, and I did delay booking my appointment multiple times. I had my second cervical screening last year and months before had been through tests for breast cancer, which all came back clear. However, knowing the dread and fear during that waiting period between the test and the results was horrific. I was nervous to go through the waiting game again."
Embarrassment was also a major factor, affecting 31.8% of those we spoke to. One participant admitted, "I felt worried about what the doctor might see. Did my vagina look weird, was there a smell, did it look different to other women's?" Another shared, "I struggle with vaginismus so I'm worried it will be painful and embarrassing."
Other concerns included:
- Not knowing what to expect – 25.2%
- The gender of the nurse or doctor – 20.6%
- Fear of judgment – 13.1%
- Concerns about body appearance – 11.2%
- Length of the process – 4.7%
- Being cold – 0.9%
- Worrying about being on their period – 0.9%
- Issues finding time – 0.9%
What do the professionals say?
We spoke with Dr Gareth Nye, a lecturer and researcher at the University of Salford, to delve deeper into the risks associated with women not 'facing their smears' and to address common misconceptions surrounding the procedure.
Dr Nye told us, "Your risk of cervical cancer is hugely increased with every missed smear test. Precancerous cells can go undetected for many years before causing any symptoms, by that time it is much more difficult to treat and your chances of having more serious outcomes increase. By missing a screening test, you are going between 6 and 10 years between screens, by this time cancers could be at a very advanced stage."
Dr Nye explains the misconceptions around cervical screenings:
- Pain: "It shouldn't be painful but it can be uncomfortable for some. To allow the speculum to fully visualise the cervix, the muscles of the pelvic floor need to be relaxed. Any tension or panic will lead to contraction of these muscles and make it more difficult for the healthcare provider and uncomfortable for you. If you do ever experience pain please talk to the person conducting the test."
- Screenings are for detecting cancer: "Smears or screens are designed to catch the disease before it becomes cancer. They are looking for changes relating to a virus, human papillomavirus, which is passed from one to another during sex and infects the cervix cells. The aim is to treat the condition with the least amount of harm to you when the virus has limited impact on the cervix. Yes, it can detect cancer, but the aim is to get there first. It's currently preventing over 70% of cervical cancer deaths."
- If screenings have always come back normal, why bother with another?: "Cancer takes years to develop and so although you have had clear tests previously, you may have developed abnormalities in the interim."
How to face your smears
As part of our campaign, we've reworked the NHS guide to facing your fears, but specifically for smears.
- Think about your physical feelings and behaviours: Notice how your body reacts when you think about your smear test—racing heart, clammy hands, or a nervous stomach. Understanding these signs is the first step in managing fear.
- Change the way you see fear: Fear triggers your "fight or flight" response, but in cases like a smear, the body can overreact to stressors that are not life-threatening. Remember, your body sometimes misreads the situation, and it's okay to push through those feelings.
- Break It Down: Focus on smaller steps – book the appointment, plan your trip, and learn about the process. Ask for what makes you comfortable, like a female doctor or a friend's support.
- Start with the easiest: Begin with simple tasks like finding the clinic or writing down appointment details. Small wins help build confidence.
- Allow yourself to feel the fear: Recognise that avoiding smear tests is more harmful than facing them. Discomfort is temporary, but attending is vital for your health.
Charlotte Measures, NHS medical negligence solicitor and accredited member of the AvMA (Action against Medical Accidents) panel explains why cervical screening is a must:
"Cervical screening is essential, even for those who've had the HPV vaccine. As a medical negligence solicitor, I've seen firsthand how devastating the consequences of delayed diagnoses or incorrect treatments can be. Smear tests are key to detecting issues early, and I urge every person who is invited to attend their screening as soon as possible.
"As the women we spoke to have shared, the fears and concerns about cervical screening are very real. However, we want to emphasise the positives—how having the opportunity to detect abnormalities before they become serious can truly be a lifesaver. We want women to feel confident, not worried or embarrassed, about attending their smear test. Every shape, size, and colour is welcome, and what matters most is taking control of your health. We want women to feel empowered by this chance to protect themselves and ensure peace of mind, knowing that early detection can save lives.
"Misdiagnosis of gynaecological issues is unfortunately common, with our research showing 1 in 4 women experience it. If you're concerned about cervical cancer, or if something doesn't feel right, don't wait—get tested. See a doctor, and if they dismiss your concerns, seek a second opinion. Keep pushing for answers. Early diagnosis is crucial. Research shows that when cervical cancer is caught early, the 5-year relative survival rate is 91%. But if it's diagnosed after it has spread, that survival rate drops to just 19%. I cannot stress enough how important it is to put any embarrassment aside and get tested—it could save your life."
Methodology
Data
Core data was taken from NHS England’s Cervical Screening Programme, England - 2023-2024 [NS] and Cervical Screening Programme Statistics – interactive resource for annual data
Sources
- Higgs LLP – Misdiagnosis: The Overlooked Crisis In Women's Health
- National Cancer Institute – Cervical Cancer Prognosis and Survival Rates
This information is for guidance purposes only and does not constitute legal advice. We recommend you seek legal advice before acting on any information given.
