Thanks to Emily Briggs, final year medical students at Birmingham University, for putting this piece together. Head to the bottom of the page to find out a little more about Emily.
The ‘smear’ is a screening test for cervical cancer that every woman in the UK, from the age of 25, is invited to have. The test is offered every three years until the age of 50, and then on a five-yearly basis up to the age of 64.
For a lot of us, our first smear is a milestone. A letter lands on your doorstep some time before your 25th birthday to invite you to make an appointment, and so heralds the second half of your twenties – and membership of this particular sisterhood.
Uptake of the UK’s National Cervical Screening is at its lowest in 20 years
Frighteningly, an increasing number of women are underestimating the importance of their smear and choosing to ignore the letter. In fact, a staggering 1 in 4 women failed to attend their smear appointments in 2017 (1). It really concerns me that the poorest uptake was amongst my own age group with only 62% of women aged 25 to 29 years attending their appointments last year. Surveys have shown that women avoid attending largely because they are embarrassed or misinformed (2,3). So why is it so important we overcome this?
Smears Save Lives
Having regular smear tests reduces your risk of developing cervical cancer to an extremely low level. The cervix is the opening to the womb (or uterus) and sits at the top of the vagina. It plays an important role in fertility, pregnancy and labour. Cervical cancer in its early stages very often has no symptoms. If symptoms do occur the most common is unusual vaginal bleeding – after sex, in between periods, or after the menopause. It is the most common cancer in women under 35 with around 3,000 cases diagnosed each year in the UK – the overwhelming majority of which are women who have not attended or have delayed their smear appointments.
The smear test detects abnormal changes in the cervix, called cell dysplasia, that have the potential to develop into cancer. Screening women at regular intervals allows doctors to pick up and remove these changes early, before they can become cancerous. In other words, the smear is not performed to diagnose cervical cancer, it is a very effective method of preventing it. Since the introduction of the UK Cervical Screening programme in the 1980s there has been a 40% reduction in rates of cervical cancer, which continues decline by around 7% each year (4).
It is estimated that approximately 2,000 lives are saved per year of screening. Recently, however, Cancer Research UK have predicted that the incidence of cervical cancer is set to increase by 43% in the next 20 years. Sadly, this rise is likely due to decreasing participation in the screening programme. It is so, so important that these predictions are not fulfilled – every woman can help their chances of not being a part of this statistic just by going for their smear.
HPV and cervical cancer
You may have heard of Human Papillomavirus (HPV). In 2008 the NHS began offering vaccinations against HPV for all girls aged 12 to 13, and this has further helped to reduce the rates of cervical cancer (5). HPV is a family of viruses that are largely responsible for causing the cell dysplasia in the cervix that can progress to cancer. HPV is extremely common, with 4 out of 5 adult women and men having had an infection at some point during their lifetime. This means that only a very small proportion of women with an HPV infection will have an abnormal smear result, and an even tinier amount will go on to develop cervical cancer. Despite this, knowing a woman’s HPV status allows us to stratify her risk if she has an equivocal smear and determine the need for further investigation.
What will happen?
It is very normal and completely understandable to feel apprehensive about your first smear. If you do feel nervous it is a good idea to talk to the women in your life – your Mum, Aunties, sisters and friends – who have already been through the process, as well as your GP. They can all reassure you that it is a swift, simple and very routine procedure.
Depending on your GP practice, the test may be carried out by a doctor or a nurse. You are absolutely within your rights to request a female, if you would prefer this. Of course, getting your lady parts out in front of a stranger is not something the majority of us are in a rush to do but it is important to remember that the healthcare professional facilitating your appointment does this all the time. They will not be able to tell if you had sex last night and they will not care if you are hairless, hairy, pierced or vajazzled. They have seen it all before, I promise.
It is advised to try and book your appointment during the middle of your cycle (so two weeks from your last period) if you can as this can ensure the best sample is taken. It is also advised that you do not use condoms, lube or spermicide in the 24 hours before your appointment as they contain chemicals that could affect the test.
You will be asked to take your underwear off and lie back on an examination table, behind a curtain. Once you are comfortable, the doctor or nurse will gently insert an instrument called a speculum into your vagina. This holds your vagina slightly open so that your cervix can be seen. A small, soft brush – similar to a very soft mascara wand – is then used to collect some cells from the surface of the cervix. This may feel a bit uncomfortable but, for most women, it is not painful. The speculum is removed – and that’s it. You can get dressed and go about your day.
Your sample will be sent off to a lab to be analysed and you will get a result within two weeks.
Following your smear test you will receive a letter in the post with your results. You will be told one of the following:
Normal – approximately 94% of results → you will be invited to have your next smear as part of the routine screening programme
Inadequate – approximately 2% of results → this mean that not enough cells were collected and the smear will need repeating
Borderline or low grade dysplasia – approximately 3% of results → this means that there were some mildly abnormal cells found, but this is often due to normal changes that occur during your cycle and will usually disappear without treatment. To determine risk following a borderline result your smear sample will be tested for HPV:
- If you are negative for HPV then you have a very low risk of developing cervical cancer before your next smear appointment and you will be invited to have your next smear as part of the routine screening programme
- If you are positive for HPV then you will be offered a colposcopy to enable doctors to examine your cervix more closely
Moderate or high grade dysplasia – approximately 1% of results → you will be offered colposcopy straight away
What is colposcopy?
Colposcopy is very similar to a smear test appointment with the addition of a specialised microscope that enables the doctor or nurse to examine the cervix more closely and take biopsies of it (tiny samples). For the majority of women colposcopy provides reassuring results and there is no need for further investigation or treatment. If abnormal cells are found during colposcopy it is possible in some cases to remove them during the clinic or you may be invited to have the removal of these cells performed as a separate procedure. There is a slight association of this treatment with problems occurring during pregnancy, but this may also be due to the abnormal changes themselves rather than the treatment (6).
Are you convinced?
Smear testing an extremely good method of preventing cervical cancer, a disease that previously affected a significant number of young women and cost many precious lives. It is really sad that rates of cervical cancer are starting to creep back up because women are choosing not to take advantage of this very simple test.
If, after reading this, you are still feeling embarrassed or anxious about having your smear please talk to someone and don’t let it prevent you from going.
Three-quarters of women do not attend their smear screening, don’t put yourself at risk by avoiding yours.
- Screening & Immunisations Team, NHS Digital. Cervical Screening Programme, England – 2016-27. Found At: www.digital.nhs.uk, Date Accessed: 12/04/18.
- Chorley AJ, Marlow LA, Forster AS, Haddrell JB, Waller J. Experiences of cervical screening and barriers to participation in the context of an organised programme: a systematic review and thematic synthesis. Psycho-oncology. 2017 Feb;26(2):161-172.
- Wardle J, Robb K, Vernon S, et al. Screening for prevention and early diagnosis of cancer(link is external). Am Psychol. 2015. doi: 10.1037/a0037357
- Cancer Research UK, June 2017.
- NHS Choices. Cervical Screening. 07/09/2015. Url: https://www.nhs.uk/conditions/cervical-screening. Date Accessed: 12/04/18.
- Kyrgiou M, Mitra A, Arbyn M, et al. Fertility and early pregnancy outcomes after treatment for cervical intraepithelial neoplasia: systematic review and meta-analysis. BMJ. 2014. doi: 10.1136/bmj.g6192.