Cervical Screening Awareness Week aims to increase the number of women in the UK attending their screening appointments.
According to Jo’s Cervical Cancer Trust, many women skip their cervical screening appointments (or don’t make any at all) because of embarrassment, with concern over body shape being the reason for over 1 in 3 women.
Another barrier is the lack of understanding surrounding the purpose and necessity of the test, with many believing it’s not necessary if you are otherwise healthy, or not believing that it reduces your risk of developing cancer.
The cervical screening process has been credited by the NHS with the prevention of 75% of all cervical cancers, as well as with aiding in early detection of cervical cancer.
What is cervical screening?
Cervical screening (formerly known as a smear test, or pap smear in the USA) is a free health test that checks the health of your cervix (the opening to your womb from your vagina).
A sample of cells will be taken from your cervix. These will then be tested for high risk types of human papillomavirus (HPV).
These cells will then be tested for abnormal precancerous changes. These could then be treated before they have the chance to turn into cancer.
The cervical screening is for women without symptoms. If you already have symptoms that you are worried about, speak to your GP, don’t wait for your routine screening.
Cervical cancer symptoms you should look out for.
Why is it done?
The purpose of the cervical screening process is to prevent cervical cancer (cancer of the cervix).
Abnormal cell changes in the cervix happen all the time, and while they usually improve on their own, they can sometimes develop into cancer.
The problem is that these abnormal changes don’t carry any symptoms. Even HPV, which can cause these changes, rarely carries any symptoms. So the only way to know if you’ve been affected is generally through a cervical screening.
If there are any changes to the cells in your cervix, the screening will detect this and further testing will be done to identify the likelihood of these cells becoming cancerous.
What is HPV?
HPV is a group of over a 100 types of viruses that affect the skin. For the most part, they don’t cause any problems and will go away on their own. But for some it can cause genital warts or develop into cancer.
How do you get it?
HPV is very common and very easy to catch; most people will have HPV at some point in their life.
You can get it through:
- Any skin-to-skin contact of the genital area
- Vaginal, anal or oral sex
- Sharing sex toys
HPV affects those who have had one partner or several. You can also get HPV if you have only ever been sexually active once.
Can it be prevented?
Unfortunately you can’t completely protect yourself from HPV, but you can improve your chances of not catching it by:
- Using condoms – although they don’t cover all of the skin around the genitals so HPV can still spread
- HPV vaccine – although it doesn’t protect from all types, it does cover ones that cause most cases of genital warts and cervical cancer
You should still attend your screening if you’ve taken precautionary measures.
HPV Risks
Most HPV infections are harmless and your body’s immune system will get rid of it on its own within 2 years, without causing any lasting damage. Because of this, most don’t even know if they’ve had it.
However, in some cases where your body doesn’t clear the infection and so the virus stays in the body for longer, they can start to cause abnormal cell changes. These abnormal cells can then develop into cancer.
Cancers linked to high-risk HPV:
- Cervical cancer
- Anal cancer
- Cancer of the penis
- Vulvar cancer
- Vaginal cancer
- Some head and neck cancers
Please remember, especially if you’re worried about this, that testing positive for HPV doesn’t tell us anything about your sex life. The virus can be passed on through any type of sexual contact, even if you’ve practiced safe sex.
Should you have a cervical screening?
Cervical screening is specifically for women and trans men with cervixes. If you don’t have a cervix because you are a trans woman, or you have had your cervix removed, you should still speak to your GP about any concerns you have about cancer or HPV.
If you have a cervix, especially if you have had any type of sexual contact (including touching and using toys) with anyone, it is important that you have a cervical screening. However there are some age groups for whom it’s not recommended.
- Under 25: Doctors don’t think it’s helpful to have a screening in this bracket as it’s common to have changes in your cell that will go away. Finding and treating these when it’s not necessary, could lead to further issues
- Over 65: You are unlikely to develop cervical cancer in this age group if your last three results were normal
The screening is still recommended for those that haven’t been sexually active for a significant amount of time. HPV can lay dormant years after you have been affected, and cause abnormal cells further down the line.
The risk of developing cervical cancer is small if you have never been sexually active, but it’s still a possibility so it’s worth having a screening regardless.
NHS Cervical Screening Programme
The programme is available in the UK for women with a cervix between the ages of 25 to 64. If you are registered to a GP as a female, you will automatically receive an invitation to book your appointment every 3 years between the ages of 24.5 and 49, and every 5 years for those between the ages of 50 and 64.
Trans men won’t receive invitations if they are registered with their GP as male, due the current IT system, but are still entitled to screening if you have a cervix. Inform your GP if you wish to have a cervical screening so that they can arrange for you to have regular tests.
PHE provides information on reducing cervical screening inequalities for trans people.
Pros and Cons
Pros
- Worldwide, cervical cancer is the fourth most common cancer in women
- The number of women dying from cervical cancer has halved since the introduction of the national cervical screening programme
- Cervical screening saves about 4,500 lives every year in England
- It is the best way to find out if you have HPV
Cons
- False Positives: on the rare occasion, the screening will show abnormal cells where there aren’t any, possibly leading to further tests
- False Negatives: some abnormal cells could be missed, giving you a result of normal cells. Regular screening should help pick up these missed cells
- It can be uncomfortable
Booking Your Smear Test
How to book a smear test appointment
If you are registered with a GP in the UK, you will receive a letter in the post inviting you to book your test (starting at 24.5 years old). Each surgery may take a different approach but generally you will be asked to either call or book online.
It’s recommended that you book your appointment as soon as you receive the letter to account for waiting times. If you missed your last appointment, you don’t need to wait for a letter to rebook.
When should you book your appointment?
It’s best to book your appointment for a time when you’re not having your period. The best time would be halfway between periods as the sample may not be clear if you’re bleeding. This also applies to if you are having treatment for vaginal discharge or a pelvic infection.
The rules for cervical screening and pregnancy are a bit more complicated.
How often should you get a smear test?
As previously mentioned, you will be invited for a smear every 3 years from the age of 25 to 29, and then every 5 years from the age of 49 to 65.
However, you may need to have more frequent tests if HPV or abnormal cells had previously been detected.
What should you let them know when you book your test?
- Women would ordinarily do the test, but request one specifically if you want to ensure you have one
- Let them know if you would like a chaperone
- Ask for more time if you feel you’d need a longer appointment
- Let them know if you find the test difficult
- Ask for a smaller speculum if you would prefer one
- Let them know if you have any concerns
Preparing for your examination
For two days leading up to your test, you shouldn’t use any spermicide, vaginal creams or lubricating jelly as the chemicals in these can affect the results. It’s also recommended to avoid intercourse and douching for 24 hours prior to your test.
What to expect on the day
The appointment will generally last about 10 minutes, but the test itself should take no more than 5 minutes.
When you enter, you will be asked to undress from the waist down (although you can usually leave on a loose skirt or dress), usually behind a screen, and will be given a sheet to cover your waist. You will then need to lie down on your back with your knees up and apart. Let the nurse if you find this position uncomfortable – you will be able to lie on your side with your knees bent up towards your chest.
The nurse will then slide a speculum (a plastic instrument) inside your vagina so that they see your cervix. Please note you can ask for a smaller speculum if you wish. The speculum can feel uncomfortable, but it doesn’t normally hurt. If you find it painful, let the nurse know as it is likely you are not feeling relaxed. Try and relax your muscles and take deep breaths to make you feel less tense.
Once your cervix is visible, the nurse will use a small brush to take a sample of cells from your cervix.
They will then take out the speculum and you can get dressed and go home.
You will be able to carry about with your normal activities after your test, although you might experience some bleeding. If you do however experience heavy bleeding or pain, contact your GP.
Make it easier for yourself
Do
- Wear a loose skirt or long jumper that you can leave on during the test
- Ask for a smaller speculum
- Ask to change positions
- Practice breathing exercises
- Bring a distraction: something to listen to, or read, or a friend
Don’t
- Keep going if you don’t want to; you can ask to stop at any time
- Hesitate to tell the nurse how you feel; communicating with them will help them know how to support you
Receiving Your Results
You will ordinarily get your results by letter within 2 weeks of your test. The letter will detail what the next steps will be. If you don’t hear anything within 6 weeks, contact your GP or sexual health clinic (wherever you had you screening).
It can be stressful waiting for your results, but remember that the aim of the screening is to prevent cancer. Most people that have a positive or abnormal test result will not develop cancer.
Understanding Your Results
There are a number of results you could receive from your test, and each come with next steps.
Normal Cells – There were no changes to the cells in your cervix. You will be asked to come back for your next screening in 3 or 5 years (depending on your age)
Unclear/Inadequate/Unsatisfactory – Your tests did not return a clear result. Either because there weren’t enough cells in the sample, or because something affected the result, such as your period or infection. You will be invited back for another test, usually in 3 months.
HPV Positive – Your sample tested positive for HPV. The cells will have then been tested further for any abnormal cells. If no abnormal cells are found, you will be asked to take the test again in a year to check if the infection has cleared on its own.
What happens when abnormal cells are found?
If the results for your cervical screening show that you have abnormal changes, it would generally mean that precancerous changes to your cervical cells have been found. This can be scary to find out, but it does not mean that you have cancer or will develop cancer.
There are different levels of abnormal cells:
Borderline or mild changes – Also called low-grade dyskaryosis. Changes such as these generally go back to normal on their own and don’t rarely turn into cancer.
Moderate or severe changes – Also called high-grade dyskaryosis. In this case, the cells are less likely to return to normal on their own, so you may need treatment.
In both cases, it is likely that you will be asked to have a further evaluation, called a colposcopy to look at your cervix more closely.
Other possible results
While this isn’t common, it is possible for the screening to find other things:
- Glandular intraepithelial neoplasia (CGIN); this can develop into an uncommon type of cervical cancer (adenocarcinoma) if left untreated.
- Cervical Cancer; on rare occasions, there may be signs of early cervical cancer. If cancer is found, you will be referred for advice about treatment.
Treating Abnormal Cervical Cells
If you have a colposcopy to check the abnormal cells in your cervix, and the doctor deduces that there is a high risk of these cells becoming cancerous, you may require treatment to remove or destroy them.
This treatment can be either done at the time of the colposcopy, if it’s obvious that the cells are abnormal, or they could take a sample for a biopsy and wait until receiving the results.
There are a number of treatments, but the most common is with a large-loop excision of the transformation zone (LLETZ). This just means that your doctor will use a wire loop with an electric current to remove the abnormal cells. You would most likely have this procedure done under local anesthesia, meaning that you will be awake.
If your doctor decides that the cells need to be destroyed, these can be done with laser therapy, freezing or cold coagulation.
Cervical screening during Covid-19
There have been a few changes in the process of getting your cervical screening, or smear test, done. At the moment, these mostly consist of having to wait longer to get an appointment, infection control methods, and a delay in receiving your results.
Please remember that the cervical screening is for those for symptoms. If you do notice any changes to your body, talk to your doctor. Even though it might not be cancer, it’s always best to get checked
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