The week beginning January 25th 2016 is Cervical Cancer Prevention Week.
This cancer usually has no obvious symptoms in its early stages, making screening vital. Young women are usually invited to attend their first smear test between the ages of 24-25. It is the most common cancer in women under 35 years of age, and around 3,100 women are diagnosed with the disease in the UK every year. The Portland Hospital will be reducing the price of cervical cancer screening during Cervical Cancer Prevention Week (24th – 29th January 2016). Throughout this week, all cervical cancer screening tests will be available for £66.
You may be concerned about your first screening and you might have a few questions that you are unsure about. Dr Freeman-Wang, a Consultant Gynaecologist at The Portland Hospital, answers some of the commonly asked questions around cervical cancer screening.
1. This will be my first smear test, what should I do to prepare?
It is helpful to read about the test and perhaps bring a friend or relative with you. The information on Jo's Trust website is very helpful.
2. Will anyone else be in the room apart from the Consultant?
Yes. There is usually a nurse or health care assistant in the room as well. They are there both as a chaperone and to assist the person performing the smear test.
3. Will the test hurt?
The test can sometimes be uncomfortable for a few minutes. Some women may have a sensitive cervix (neck of the womb), so may experience a period like pain, but this is uncommon.
4. How long will it take?
The consultation and examination will take around 20 minutes. The test itself takes three minutes or so.
5. What does a smear test look for?
The 'smear' or more accurately 'cervical cytology' is a screening test looking for abnormal or premalignant cell changes of the cervix, which if detected can be monitored or treated in order to prevent cervical cancer.
6. Why are women aged 25 advised to attend their first test?
In England and Northern Ireland women are invited to attend their first smear test aged 24 and a half. The screen age was changed in 2003. There is a great deal of evidence that shows screening too early may cause more harm than good. In women under 25 years, 1 in 3 may have an abnormal screen test that would need further investigation and perhaps treatment.
However given time, many of these changes may spontaneously resolve. Thus far there is no evidence that there have been any increase in deaths from cervical cancer in the 20-25 or 25-30 year age group. Therefore screening too early may lead to young women being over treated and increase their subsequent risk of preterm labour.
The U.K. National screening committee has recently agreed that Scotland and Wales will change the age of a woman’s first cervical screening to 25. The International Agency for Research on Cancer (IARC) has stated "There is minimal benefit and substantial harm in screening below age 25. Organised programmes should not include women aged less than 25 years in their target populations."
It is also important to be aware that the cytology (smear) test is for screening. It is not for investigating symptoms. Regardless of age, if you have symptoms of bleeding in between your periods or after sexual intercourse, you should make an appointment to see your doctor.
7. Can I have a smear test while pregnant?
Yes, it is possible to have a smear test in pregnancy, however because we have effective screening programmes in the UK, it is rarely necessary. Another potential challenge is that the cytologist (the clinician who reads the smear) may find it more difficult to assess the cells of a smear taken from a pregnant woman. This is because of a range of normally occurring changes that occur in pregnancy. Thus the chances of the test being reported as inadequate are slightly raised.
If a woman has not had a smear test in the previous three years, or never had a smear, it may be advisable to get one done.
8. If abnormal cells are found, what does this mean and what are the next steps?
About 10% of women who have a cervical screening test will receive an abnormal result. Sometimes it may be that there are insufficient cells in the sample - an inadequate result. In this case you may be called back for a repeat test in three months. If the same inadequate result occurs on three separate occasions it would be advisable to have a further screening test called a colposcopy. This involves a more detailed examination of the cervix. This investigation if the cytology result is reported as having dyskaryosis. This term refers to the abnormal cells and may be low grade dyskaryosis or high grade dyskaryosis. It is very rare that either of these results will have cancer, but it is important that the cervix is carefully examined and currently the only way is by colposcopy.
9. What happens during a colposcopy?
The cervix is visualised following the insertion of a speculum. This is exactly the same process as when having a smear performed. The difference is that a couple of solutions are put on the cervix in turn and it is inspected through a colposcope - a binocular instrument which provides both magnification and good light.
It may be necessary to take a very tiny sample of tissue (a punch biopsy) to send to the laboratory to compare with the smear and the colposcopy findings. If so a little local anaesthetic may be used. There is usually some very light bleeding afterwards which can continue for up to seven days. A few women experience period like pain afterwards for a short time. It is advisable to avoid sexual intercourse until the bleeding stops.
In the last three years cervical screening has changed slightly. It has been known for some time that a group of viruses are integral in the development of cervical cancer. This group of viruses are called human papillomaviruses (HPV).
HPV is common and will occur in 70-80% of the reproductive population at some point. Importantly in the vast majority of cases, the body's immune system will clear the viruses. This can take 12-18 months on average. About 10% of women are unable to clear the viruses. The reason is not as yet understood. People who are unable to clear the HPV are more likely to develop an abnormal screen test over time.
When a cytology test is reported as a borderline abnormality or low grade dyskaryosis, the laboratory will automatically perform an HPV test on the sample. If there is no HPV present (HPV negative) then no further action is required. Some may advise a repeat test in a year, but within the screening programme it is safe to return to a normal recall.
If there is evidence of HPV (HPV positive) then a colposcopy is indicated.