Cervical Cancer Screening
All women aged between 21 and 65 are recommended to get cervical screening in the US. Also called a smear test or pap test, it’s a test aiming to prevent cancer rather than a test for whether you have cancer. It checks for a certain virus that can disrupt the cells of the cervix (the opening to your womb from your vagina). If you have the virus, the cells of the cervix can then be checked for any changes that could, with time, lead to cervical cancer.
Rescreening is recommended every 3 years. After the age of 65 you’ll only need screening if your last test was abnormal or if you’re in a higher risk group (HIV positive, weakened immune system, exposed to diethylstilbesterol [DES] before birth).
Cervical cancer is not one of the most common cancers, but it is common in young women, usually affecting those in their early 30s. Once you have cervical cancer, treatment can be difficult and threaten your fertility and your overall health. But it's considered 99.8% preventable, so it's worth keeping up with your cervical screenings.
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What does screening involve?
The test involves you lying on a bed and a nurse or doctor using a speculum, a small plastic instrument, to pass through the vagina to your cervix. They use a tiny soft narrow brush to take a small sample of cells, which they put in a specimen jar or on a slide and send off to a lab.
It’s a relatively quick procedure, and not usually painful but it may be a little uncomfortable. It’s easier said than done, but the more relaxed you are, the quicker and more comfortable the procedure. Deep slow breathing, in through your nose and out through your mouth, can help keep you relaxed. Your doctor or nurse will give tips on positioning to help.
Make sure you’re not on your period when you go for your smear test, as the lab will be unable to interpret results. You may feel embarrassed, but be reassured that the nurse or doctor is very used to doing these tests and talking you through it.
What if they find something?
You should get the results of your smear test within days, and it will inform you of the next steps. Cervical screening doesn’t test for cancer cells as such, but instead tests for changes that could lead to cancer if left untreated.
The lab tests cervical cells for whether Human Papilloma Virus (HPV) is present, as certain high risk strains can cause changes to the cervical cells. If you don’t have HPV, this is regarded as a negative result and that your chance of developing cervical cancer is extremely low. You can then await your next screening invitation.
If one of these strains is found, the lab then looks at the cervical cells for evidence of change (dysplasia). If there are no cervical cell changes, you simply await the invitation for your next smear test, but it will be brought forward, usually within a year.
If there are cell changes, you will be offered treatment in a procedure called a colposcopy to prevent further disruption to the cervix, and ultimately to prevent cancer.
What if I have symptoms but I’m not due a screening test?
You shouldn’t wait for cervical screening if you have any symptoms, and instead, book an appointment with your doctor at the earliest opportunity. Symptoms include unusual discharge, vaginal bleeding either after sex or between your periods, or pain during sex. Book an appointment even if you have had a recent negative smear test, as no screening test is 100% reliable.
Similarly, if you have a speculum procedure for any reason and the nurse or doctor sees any abnormalities, they will not take a smear test, but will refer you directly and urgently for colposcopy.
How did I get HPV?
It’s very common to contract this if you’re sexually active. It usually causes no symptoms, and for most women, your body will naturally clear it in a few years. It should carry no embarrassment or shame - you can get it if you have only had one sexual partner or lots, or if you are in a same-sex relationship. It can be transmitted through vaginal, oral or anal sex, sharing sex toys or from any genital skin contact.
The chance of HPV has been much reduced since the introduction of HPV vaccines, offered to all girls and boys aged 11 to 12. While it doesn’t eliminate the risk, the hope is that finding high-risk strains of HPV and, indeed, cervical cell changes will be much reduced as this generation reach their 20s, 30s and 40s.
If you have never been sexually active, your risk of HPV is virtually nil, and therefore the risk of changes to cervical cells is very low. So you may choose to pass on the invite of a smear test (you can accept at a later date), or you can choose to have it done.
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