Cervical cancer and cervical screening


This article was written by one of The Food Medic team; GP – Dr Nirja Joshi


What is cervical screening?

Cervical screening, sometimes referred to as a ‘smear test’, is a test to check the health of your cervix. It is designed to help screen for and prevent changes which may increase your risk of cervical cancer developing (1, 2). It helps prevent cervical cancer by checking for a virus called high-risk HPV and cervical cell changes. It is not a test for cancer. 

What is HPV?

Human Papilloma Virus (HPV) is a virus which can be transmitted from skin to skin contact or sexual activity (3). HPV viruses often do not cause symptoms. Some types of HPV can cause issues such as skin or genital warts. Other types of HPV are higher risk and can be precursors to certain cancers, including cervical cancer, but also anal cancers, penile cancers cancers of the head and neck and vulval cancers. 

How to protect yourself from HPV?

Using condoms can reduce the risk of HPV transmission. In addition, there is a vaccination programme in the UK where boys and girls aged 12 and 13. If you were eligible for this, but missed the vaccination programme, the NHS will offer this free of charge until your 25th birthday (4). Men who have sex with men, or are bi-sexual have been eligible to have this vaccine until the age of 45 when they visit a sexual health service. Trans women are eligible for the vaccine, as are trans men if they have sex with men until the age of 45 (5). 

If the vaccine was not available for you on a national programme and you are thinking about having this, you are able to get this privately, however, efficacy is thought to be lower as one gets older as they are likely to have been exposed to HPV at this stage (4). 

What happens when you get your cervical screening test? (1, 6)

After being invited to be screened, you will book an appointment with you GP surgery. This test is most commonly performed by nurses who receive special training to perform these tests. Sometimes these tests may be done by your GP, or by a sexual health clinic.

You can only have this test if you are not bleeding, hence it is important to schedule this at a time where you are not likely to be on your period. You will be asked if you would like a chaperone for this examination. Thereafter, you will be asked to undress from the waist down and be given a cover for your lower half to maintain dignity. Your feet will either be positioned together, or on stirrups, and you will be asked to relax your buttocks as this will help the speculum to pass. A speculum is a plastic tube which allows the healthcare professional to visualise your cervix. Thereafter, a small brush will be used to take a sample of cells from your cervix and this will be placed into fluid which is then sent to the laboratory for analysis. This process can be uncomfortable, but if you ever experience pain, you can let the healthcare professional know so that they can stop. The whole test will only last a few minutes, and the results are incredibly valuable, so the test is certainly worth doing. If you are particularly anxious about your test, please do communicate this as there are techniques to use to help the procedure be smoother for you.

After screening, you may have some abdominal or vaginal discomfort, some women may experience light bleeding (6).

How often should you be screened?

All women from the age of 25 to 64 will be invited to have cervical screening by letter. This will happen every 3 years until the age of 50, and every 5 years thereafter (this will be every 5 years from 25 to 64 in Wales and Scotland). If you are found to have something to warrant you to have more regular screening, you will be contacted accordingly (1). 

Often, women will ask if they can have a smear test done at another time e.g. during a sexual health check. Unfortunately, screening tests are designed to be done at intervals to pick up changes, if you have a smear test conducted on the NHS and you have not been invited to have screening, the sample will be discarded. Some women may choose to have cervical screening privately. 

During the pandemic, as routine care was put on hold, a lot of women missed their routine cervical screening. If this has been the case for you, please contact your GP surgery and check if you are due a test, they will be able to book this in for you. The Lancet published that risk-stratifying women would be the most effective way of ensuring that there is a sufficient catch up for women after cervical screening.

What about the results?

You will be notified of the results of your smear test, if these are abnormal you may be asked to have your next screening sooner than you would expect, or you may be sent for a colposcopy. 

A colposcopy is a camera which looks at your cervix directly, from there, it may be possible to take biopsies which are then analysed to look for cell changes. If you are found to be HPV positive, it is important to note that your body can clear HPV naturally, but it can take some time, hence you will be asked to come for more frequent screening to monitor you more closely. It is important to find any changes early, as this improves the success rate of treatment.

Jo’s trust offer more detail about the potential results that you could recieve. 

What changes have happened with cervical screening?

In England, Scotland and Wales, cervical screening is based on detecting HPV, if the sample is positive for a high risk HPV, the laboratory will test your sample for cell changes. In Northern Ireland, the laboratory checks firstly for cell changes, then for HPV, although they are likely to align with the rest of the UK in the near future (1). 

What new changes may be coming up in the future?

In February 2021 a trial began of allowing women who were more than 15 months overdue on their smear tests in 166 GP surgeries to trial a self swab at home. This removes a lot of the traditional barriers of smear tests and helps to capture individuals who have missed screening and hence may be at higher risk. This process is already in place in other countries such as Australia, and hence it may become more common in the future (7). 

When should you not wait for screening and see your doctor?

Screening is only recommended for women without symptoms, however, if you have any symptoms such as abnormal bleeding (in between your periods or after sex), or any symptoms which are not normal for your body, please do see your doctor. 

Charities which can help you

If you have been diagnosed with cervical cancer, or have questions or concerns, Jo’s Trust (8) is a charity designed to help with this; https://www.jostrust.org.uk/


References

  1. NHS. Cervical Screening [Internet]. 2020 [cited 2022 Jun 6]. Available from: https://www.nhs.uk/conditions/cervical-screening/
  2. Jo’s cervical cancer trust. What happens at cervical screening? [Internet]. 2022 [cited 2022 Jun 8]. Available from: https://www.jostrust.org.uk/information/cervical-screening/what-is-cervical-screening
  3. NHS. Cervical screening: why it’s important [Internet]. 2020 [cited 2022 Jun 6]. Available from: https://www.nhs.uk/conditions/cervical-screening/why-its-important/
  4. NHS. Human Papilloma Virus [Internet]. 2019 [cited 2022 Jun 5]. Available from: https://www.nhs.uk/conditions/human-papilloma-virus-hpv/
  5. NHS. HPV vaccine overview [Internet]. 2019 [cited 2022 Jun 10]. Available from: https://www.nhs.uk/conditions/vaccinations/hpv-human-papillomavirus-vaccine/
  6. Jo’s Trust. Our cervical cancer screening tips [Internet]. 2021 [cited 2022 Jun 10]. Available from: https://www.jostrust.org.uk/information/cervical-screening/cervical-screening-tips
  7. NHS. NHS gives women Human Papillomavirus Virus (HPV) home testing kits to cut cancer deaths [Internet]. 2021 [cited 2022 Jun 6]. Available from: https://www.england.nhs.uk/2021/02/nhs-gives-women-hpv-home-testing-kits-to-cut-cancer-deaths/
  8. Jo’s cervical cancer trust. Get Support [Internet]. [cited 2022 Jun 9]. Available from: https://www.jostrust.org.uk/get-support
  9. NHS. Cervical Cancer: Overview [Internet]. 2021 [cited 2022 Jun 8]. Available from: https://www.nhs.uk/conditions/cervical-cancer/

Cervical cancer and cervical screening was last modified: June 13th, 2022 by Nirja Joshi



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