I think we can safely say that no one likes going for a smear test. They can be a little awkward, slightly uncomfortable and waiting for any kind of result is a bit nerve-wracking. But they're nothing to be afraid of - in fact, they can be a life-saving (it's estimated that if everyone attended screening regularly, 83% of cervical cancer cases could be prevented).
Unfortunately, the results of a recent survey by Public Health England has revealed that cervical screening attendance is at a twenty-year low, with only one in four eligible women not attending their tests - and the pandemic has not helped matters.
Dr Belinda Griffiths from The Fleet Street Clinic notes that in March 2020, the number of cervical smears halved, yet the clinic was open and observing all the rules for social distancing, hygiene, PPE and avoidance of risk in the form of possible Covid-19 infection.
"It is very important to have cervical smears done regularly and to follow up previous abnormal results with another smear test as required," she explained. "Failure to do so can result in surgical procedures which are more radical than would be necessary if abnormalities were picked up earlier. If early changes on the cervix are left, a larger area of the cervix has to be removed in order to clear the possibly cancerous changes, which in turn, can lead to subsequent difficulty in pregnancy and a higher risk of miscarriage, than would have been the case if treated earlier."
To help answer any questions you may have, we've called upon Rebecca Shoosmith, head of support services at the UK's leading cervical screening charity, Jo's Trust, to set the record straight ahead of yours...
What is a smear test?
A smear test, otherwise known as cervical screening, is a short five to 15 minute test that checks the health of the cervix. It is not a test for cancer - rather, it is a test that helps to prevent cancer.
The test is performed by a qualified nurse or doctor and involves a visual inspection of the cervix as well as collection of a small sample of cells. For the test, you will need to undress from the waist down (although you can cover up with a paper sheet if preferred) and lie back with legs bent, knees down and feet together. The practitioner will slowly insert a small tube known as a speculum into the vagina (don't worry, they can use lubrication if needed or you can ask for a smaller speculum), which gently opens up to reveal the top of the cervix. Then, a few cells are collected using a soft brush, which are then sent to the labs and tested for abnormalities and human papillomavirus (HPV).
Does it hurt?
Everyone's experience of a smear test is different, with the majority of women reporting no pain or mild discomfort. However, some women do find that the test is painful and there are many psychological factors that come into play and make the situation worse. The most important thing is to remember that you can ask to stop at any point, and also to tell your nurse or doctor if you are feeling anxious as they will be able to make suggestions to help you feel more comfortable.
"It’s very normal to be nervous about a smear test, but there are lots of ways that you can make a smear test more comfortable," says Rebecca. "You can take someone you trust with you, or listen to something with headphones to distract you. Lots of people find it helpful to wear a skirt or dress so that they feel less exposed. Try to remember that the actual test is over in about a minute. Most importantly, make sure you speak to your nurse and let them know that you’re nervous – they have done this test many times before and want to put you at ease."
Who is eligible for a smear test?
Women under the age of 25 are not invited for a smear test due to the fact that cervical cancer is rare in this age group, and cell changes in that age group often return to normal.
Women between the ages of 25 and 49 will be invited to attend a screening every three years (you usually receive a letter in the post through your GP). Women aged 50-64 are invited once every five years, and women over 65 are only invited if one of their last three tests were abnormal.
What happens if my results come back as abnormal?
First of all, do not panic. An abnormal smear test result does not mean you have cancer. "If your results are abnormal, you may be told you have HPV or cell changes. Finding out your result is abnormal may be worrying, but try to remember that HPV and cell changes are not cervical cancer. You may be invited for further tests. Most cell changes will get better by themselves, or with treatment."
If your results come back as abnormal, you may be invited to another test known as a colposcopy, which is very similar to a smear test but takes a closer look at your cervix. This is usually done in your local hospital and takes no more than half an hour. No anesthetic is required and you can go home the same day.
Where does human papillomavirus (HPV) come into it?
Human papillomavirus (HPV) is a common virus that most of us will have at some point in our lives (in fact, 90% of people will come into contact with the virus at some point in their lives).
"There are over 200 types, each with its own number," explains Rebecca. "13 HPV types are linked to cancer. These types are called high-risk HPV. The body usually clears HPV infection without it doing the body any harm but sometimes it can cause cells to change." Rebecca goes on to explain that HPV can lie dormant within the body without being detected for years - even decades - before becoming active again.
It used to be the case that the samples collected from a cervical screening were first tested for abnormal cells, and if the results came back positive, the sample would be tested for HPV. However, this is changing and cervical screening across the UK is starting to test for HPV first.
"A HPV test is carried out on the sample collected during a smear test, this is a new testing method which is more sensitive at identifying women at greater risk of cervical cancer than the old method of looking at the sample for cell changes first. If HPV is found, then the cells will be looked at."
Is HPV a sexually transmitted infection?
While you can catch HPV from sex, it can also be transmitted from skin-on-skin contact with the genital areas. Many of the different strains do not cause any problems, nor have any symptoms, but others can cause genital warts and an increased risk of cancer. Although condoms can offer some protection, they do not fully protect you from HPV, which is why regular screening is essential.
Do I still need to have a smear test if I've had the HPV vaccine?
In short, yes as Rebecca explains; "The vaccine protects against around 70% of cervical cancers. There are some HPV types it does not protect against and this is why smear tests are so important."
Who is eligible for the HPV vaccine?
Currently, the vaccine is offered free in schools to girls and boys aged 11 to 12 in Scotland and aged 12 to 13 in the rest of the UK. "For girls who were offered the HPV vaccine but missed having it in school, you can have it free up to age 25 in England, Scotland and Wales," says Rachel.
Are there any alternatives to a traditional smear test?
A new, at-home urine test made headlines last year as a potential alternative to the traditional smear test. "Urine testing could be a fantastic innovation however it’s early days and we need further research including clinical evidence of how effective it is."
This article was originally published on Glamour UK.
