What is cervical cancer screening?
The cervix is the neck of the womb with an opening into the vagina. Cervical screening (once called a smear test) is routinely used to check the health of a woman’s cervix. It is a simple procedure, where a soft brush is used to gently sweep cells from the cervix. It does not directly test for cancer but checks for certain ‘high risk’ variants of Human Papilloma Virus (HPV), which are found in over 99% of all cervical cancers. (as well as in less common cancers, including vulval, vagina, anus, head, and neck).
What is Human Papilloma Virus (HPV)?
HPV itself is a common virus, with most of the population getting it at some point in their life. There are many different types. Some cause conditions such as genital warts and verrucae. There are some high-risk types of HPV that can transform cells over several years to develop into cervical cancer (and other cancers, including vulval, vagina, anus, head, and neck)
Majority of people do not know they carry the virus as it often clears itself. Even in those with high-risk HPV, that develops into cervical cancer, symptoms are not common, which is why attending regular screening when invited is so important.
Who is offered cervical screening?
In England, NHS cervical screening is offered to anyone with a cervix aged 25 to 64, including those in same-sex relationships, transgender, and non-binary people with female reproductive organs. It’s only ever 3-5 years depending on your age:
· Ages 25 to 49: Every 3 years
· Ages of 50 to 64: Every 5 years
· Above age 64- You may be offered screening if one of the last three test you had was abnormal.
· If you fall pregnant when your screening is due, you will be asked to delay your test until 3 months after you have had your baby (unless you previously were at high risk of developing cervical cancer)
What does my cervical cancer screening test result mean?
· If the sample is negative for ‘high risk HPV’, there is no need for further investigations.
· If the sample is positive for ‘high risk HPV’, you will be referred for further investigation to look at the cervix in more detail and establish if there are any changes to the cells (*see end of leaflet for more detail).
If there are changes, you will either be offered more regular screening or treatment. Even if you carry high-risk HPV, the chance of getting cervical cancer is low, because the aim of screening is to pick up changes early so that they can be easily treated and do not turn into cervical cancer. Some women will clear the virus without it causing changes to the cervix but may still need more regular monitoring.
· If the sample is inadequate, this indicates there was not enough sample or the sample could not be interpreted (for example due to contamination from infection or blood). You will be invited for a repeat screening 3 months later.
Do I need extra screening if I have symptoms?
The screening test is routinely used in those women who do not have symptoms. If you are experiencing symptoms such as bleeding after sex, bloody vaginal discharge, or bleeding in between periods, you should contact your doctor as soon as possible for an examination. If the cervix has any concerning features, you will be referred directly to the gynaecologists or for colposcopy (a small camera used to look at the cervix in detail)
Can HPV be prevented?
HPV is common amongst sexually active individuals. It often clears itself but as it can lead to STIs such as warts, it is important to use barrier protection such as condoms during sex.
As well as screening, routine vaccination programme against HPV was introduced in 2008 to girls aged 12-13, with a catch-up programme from 13-18, and further one at 25. Since 2018, herd protection has started to be rolled out to all girls and boys aged 12-13. The aim is not only to prevent female genital cancers but also to protect both sexes from other HPV-related cancers such as head and neck.
*My cervical screening HPV test is positive- all the scenarios explained:
The next step if HPV is found on a screening test, that sample will be sent for looking at under a microscope -‘smear’ test
Normal ‘smear’ cells– back to routine 3-5 yearly HPV screening
Abnormal ‘smear’ cells– you will then be invited for colposcopy where a specialist will perform a speculum examination and look at the cervix under a microscope:
· Cervix looks normal under microscope- back to routine 3-5 yearly HPV screening
· Cervix looks abnormal under microscope – biopsy will be taken, and the results will take ~4-6 weeks
– Biopsy normal – back to routine 3-5 yearly HPV screening
– Biopsy CIN I (low risk pre cancer)– screening will be repeated in 12 months
– Biopsy CIN II – (high risk pre cancer)– follow up in colposcopy to remove the cells à ‘test to cure’ repeat screening test in 6 months to check all abnormal cells have been removed
– Biopsy CIN III or CGIN (glandular) – (high risk pre cancer) – follow up in colposcopy to remove the cells à ‘test to cure’ repeat screening test in 6 months to check all abnormal cells have been removed
For more support on cervical cancer awareness or to book your cervical screening test, visit our women’s heath and gynaecology clinic
