Screening

Prevention is our strongest weapon in the fight against cervical cancer. In this respect, women in the UK are fortunate because in 1988 a national screening programme was introduced specifically to reduce the incidence of cervical cancer. The NHS Cervical Screening programme is now so effective it saves approximately 4,500 women lives every year.
 

PLEASE attend your invitation for a smear test as it could save your life!

What is a smear test?

Is a smear test a test for cancer?

What happens during a smear test?

Helpful tips before your smear test

Positive points about smear tests

Is having a smear test painful?

How long should it take to receive the result of a smear test?

How will I get my  smear test result?

Can a smear test diagnose cancer?

Who is eligible for a smear test on the NHS?

How many women attend for screening in the UK?

Why was the age raised from 20 to 25 for young women to receive their first invitation to attend for a smear test?

Is a smear test reliable?

What do the results of the cervical smear test mean?

Why are some cervical abnormalities missed?

How can CIN1 become CIN3 in 6 months?

Will a smear test give a final diagnosis?

Does an abnormal smear test mean I have cancer?

Why do some women get abnormal smear results and others never do?

Is having a smear test like having a gynaecological MOT?

Do I have to arrange a smear test?

Can I have a smear test when I am pregnant?

What is Liquid based Cytology?

Should gay women have smear tests?

I have never been sexually active so should I have a smear test?

I have had a hysterectomy so should I continue to have smear tests?

What is a smear test? 

A smear test is a method of examining stained cells in a cervical smear for the early detection of abnormal changes, which if undetected could at a future time develop into cervical cancer. This is why it is important for women to attend their invitation for a smear test, which also affords the opportunity for the cervix and womb to be examined for any problems. Having a smear test regularly provides a very high degree of protection against developing cervical cancer.

Is a smear test a test for cancer? 

A smear test is NOT a test for cancer. Instead it is a screening test to detect abnormalities (pre-cancer) at an early stage in the cells in the cervix.

What happens during a smear test?

Having a routine smear test should take a matter of minutes and should not be painful. The majority of women do not feel any discomfort during a smear test but some do and it can be helpful to find out as much about having a smear test beforehand, particularly if it is your first one. Please do let the doctor or nurse know of any pain or other problems experienced during your smear test.

GP's and Practice nurses take the majority of smear tests in the UK. Before the procedure starts the doctor or nurse should explain what is going to happen and answer any questions or concerns you may have.

You will be asked to undress from the waist down and to lie on an examination bed either on your back with your legs bent up and apart or sometimes lying on your side with your legs bent up. Choose the position that is most comfortable for you.The doctor or nurse will then insert an instrument called a speculum into the vagina to allow them to see the cervix. A wooden spatula is then wiped or scraped over the surface of the cervix to remove some cells, which are then transferred to a glass slide. The doctor or nurse may also do an internal examination to check for any problems.

Helpful tips before your smear test 

Do not worry if you feel anxious about having a smear test!  For many women the thought of having a smear test is often worse than the reality! It can help to be as informed as possible about what having a smear test is like before your appointment.

Positive points about smear tests:

• An abnormal smear rarely means cancer
• Between 90 and 93% of all smear test results are normal
• Having a regular smear test offers the best protection against developing cervical cnacer
• A smear test is free and you receive your invitation to attend for regular screening from your GP. (It is important that you let your GP know of any change of name or address)
• Every year around 4.2 million women in the UK have a smear test, which research has proven saves 4,500 lives
• If you are feeling anxious beforehand ask a member of your family or friend to accompany you or ask your GP to prescribe a mild sedative, which would be best taken an hour before your test. (Do check about driving afterwards as it may not be advised)
• Your GP or Practice nurse will always be happy to talk through any anxieties that you have prior to your smear test appointment
• Do not have sexual intercourse in the 24 hours before your smear test. The use of sperm, spermicidal gel, and lubricants before your test may make it difficult to get a good sample of cells
• If vaginal pessaries have been prescribed to treat an infection then postpone your smear test for at least a week after the treatment has finished
• If you are using a vaginal oestrogen cream for menopause symptoms, do not apply it on the day of your smear
• Do not douche or use a tampon for at least two days before your smear

Is having a smear test painful?  

Over 4 million women have a smear test every year; 90 to 93% of whom receive a normal result. The smear test should not be a painful procedure but some women can experience a degree of discomfort and even short-term pain. Having a smear test (especially if it's the first one) can be daunting for some so it may help at the appointment if you find out beforehand exactly what happens during a smear test. A smear test should take approximately two minutes but if during the procedure  you feel any pain and/or discomfort please inform the GP/Practice nurse.

How long should it take to receive the result of a smear test?

This can vary depending on where you live so it is important that you ask your GP or Practice nurse at the end of your appointment  how long the results make take. If you have not received the result by this given date then do ring and check.

How will I get my  smear test result?

This can vary so do ask at the time of your smear test how will they let you know your test result. The smear test taken by either your GP or Practice nurse is reviewed by specialists at a hospital cytology department. If there are no abnormalities seen (the test is 'normal') then they will inform your GP. Sometimes the hospital may contact you with the result but it is is usually the GP's surgery who sends the letter. Some GP's request the patient to ring for their result - do check if they would like you to do this.

If the specialist looking at the smear test feels it would be advisable for you to be reviewed by a hospital doctor then they will inform your GP. In some areas there is an agreement between the hospital and the GP's surgeries that the woman is informed by letter directly from the hospital, and an appointment is made and enclosed in the same mailing.

Can a smear test diagnose cancer?  

It is rare for cervical cancer to be diagnosed by a smear test. Cervical screening does not diagnose cancer itself but abnormalities can be detected, which may indicate further tests are required. Depending on the type of these tests and their results a diagnosis of cervical cancer can be made.

Who is eligible for a smear test on the NHS?

How many women attend for screening in the UK?

Between 3.5 and 4.5 million women are invited to attend for screening each year and since 1997 the numbers of women attending for screening n the UK has remained steady at approximately 77% to 80%.

However analysis by age reveals a slow but steady decline in women aged under 50 attending for screening with a slight increase in the number of women aged 55-64 attending.

Why was the age raised in England from 20 to 25 for young women to receive their first invitation to attend for a smear test?

Statistics state that the incidence of cervical cancer in teenage girls is rare in the UK and following a study conducted by Cancer Research UK (CRUK), 'Benefit of cervical screening at different ages: evidence from the UK audit of screening histories' the NHS Cervical Screening programme raised the age from 20 to 25. This change came into effect in England in September, 2004. Scotland and Wales continue to invite women aged 20 for their first smear test.
 

For further information about the study: http://www.nature.com/bjc/journal/v89/n1/abs/6600974a.html

Is a smear test reliable?

The smear test is 80% to 90% reliable and can prevent 70% of cervical cancers. This means that approximately 7 cases can be prevented out of every 10 women who would have developed cancer of the cervix. Approximately 7 to 10% of cervical smears show atypical or abnormal cells.

What do the results of the cervical smear test mean?

Normal result
Approximately 9 out of 10 routine cervical smears are normal. Following a normal result a letter will be sent inviting you for another one in 3-5 years. (Note: a normal result means you have a very low chance of developing cancer of the cervix - not a 100% guarantee that it will not occur.)

Inadequate smear
To receive an inadequate smear is not uncommon and simply means that no result can be given. This may occur because there was too much blood or not enough cervical cells in the sample.

Also many lubricants and possibly other medical creams and lotions may affect the preparation of the sample so that cervical cells are not picked up by the laboratory processing method.  If you are using any such creams or lotions you should advise the smear taker first.

You can ask why your test was inadeqaute. You will be asked to attend for a repeat smear.

Abnormal result
Some changes are found in cervical cells in approximately 1 in 10 smear tests. There is a range of changes that occur that are detected through cervical screening. See pre-cancer

Why are some cervical abnormalities missed?

There are several factors in the taking and reading of smear tests which makes it impossible to be 100% accurate . A cervical smear is a sample of cells taken from the surface of the cervical skin. Because it is only a sample the cervical smear does not always accurately reflect what is occurring in the whole of the skin layer - and it is the latter which is important to make an accurate as possible diagnosis.

How can CIN1 become CIN3 in 6 months?

When a test result shows a minor abnormality (CIN1) you may not be advised to have any treatment but you will be asked to have a further smear test.  This is so the doctors can check that the area of abnormality either reverts back to normal, or stays the same (as a minor abnormality) or progresses to a more severe change where treatment is recommended. If this second test result shows a CIN3 it indicates that there is an area on your cervix that is undergoing a more severe change. This was either not sampled in the first smear test (a smear test will only take a sample of cells) or the area has undergone a more rapid progression of change since the previous test.

Will a smear test give a final diagnosis?

No. It is important to remember that a smear test is a screening test and not designed to give a final diagnosis. It is used to detect early cervical cell abnormalities which, if left untreated, could lead to the development of cervical cancer at a time in the future.  It is understandable to feel anxious if you receive an abnormal result but it is more important that you know and understand what the abnormality is so you can discuss the results with your doctor and arrange appropriate follow-up.

Does an abnormal smear test mean I have cancer?

No. The majority of smear test results are normal but a very small percentage of the total smears reported on every year are described as being either 'inadequate' or having a grade of abnormality. The majority of these abnormalities reflect pre-cancerous changes in the cells of the cervix. See pre-cancer

Why do some women get abnormal smear results and others never do?  

The most important factor in why some women never have abnormal smear tests while others do is a woman's own immune system. Infection with HPV is present in 99.7% of all cervical cancers diagnosed so it is your immune system's ability to get rid of this virus quickly and 99% of women usually do. However, those who do not achieve this are at risk of subsequently developing changes in the cells abnormalities, which if undetected and left untreated may develop into cervical cancer at a time in the future.

If cervical cell abnormalities have been detected this does NOT mean that you have cervical cancer or will get cervical cancer in the future. What it does mean is that some of the cells are slightly abnormal and that if left untreated could go on to develop into cervical cancer at a later date.

Medical research has yet to establish why some women have persistent HPV infection, develop pre-cancerous abnormal cell changes, or cervical cancer. This is why it is important for all women aged 25 - 64 to attend their NHS invitation for a smear test.

Is having a smear test like having a gynaecological MOT?

No. A smear test is designed solely to detect early cervical cell abnormalities which, if left untreated, could lead to the development of cervical cancer at a time in the future. It is not designed to detect abnormalities in the ovaries, the womb, the vulva or the vagina. However, having a regular smear test does give the opportunity for the cervix to be examined.
 

Do I arrange my smear test?  

No, provided you are registered with a GP, who has your correct and current address on file. The NHS call and re-call system invites who are eligible for screening who are registered with a GP. This system also keeps track of any follow-up investigation, and, if all is well, re-calls you for screening at the appropriate time for you - either three to five years. It is therefore important that you ensure that your GP has any change of circumstance or address.

Women who are eligible and who have not previously had a smear test may be offered one when they attend their GP, or family planning clinic on another matter. Women should receive their first invitation for routine screening by their 25th birthday. If you are eligible and have not received an invitation to attend for cervical screening then you should contact your GP. If you have never had a smear test or are aged under 25 PLEASE contact your GP if you are worried about irregular bleeding between periods or after intercourse or unusual pelvic pain and pain during intercourse.

Can I have a smear test when I am pregnant?

Every woman's smear history is different and offering a smear test when she is (or might be) pregnant will be dependent on this history. If you have had abnormal smears in the past or never had a smear test or had not attended previous invitations for screening, then you should consult your doctor or practice nurse to ask for advice.

What is Liquid based Cytology?

This is a test similar to the cervical smear but uses a brush-like device rather than a spatula. The head of the device is then placed, or broken off, into a vial of liquid rather than the cells being smeared onto a slide. The contents of the vial are spun and treated to remove obscuring material, thereby aiming to address the problem of inadequate smears where no result can be issued by the cytologist/laboratory because the abnormal cells are obscured.

Should gay women have smear tests?

Gay women, even those who have never had sex with a man, are still at risk of developing abnormal cervical changes and should get regular smear tests.

I have never been sexually active so should I have a smear test?  

The incidence of cervical cancer is extremely rare in women who have never been sexually active and the guidelines issued suggest that women who are sexually active attend for screening at the age of 25. More than 90% of cervical cancers are linked to infection with the sexually transmitted human papilloma virus (HPV) so it is recommended that if you have had sexual intercourse or genital-to-genital contact with a man or a woman, even just once, then you should attend for regular smear tests.

I have had a hysterectomy so should I continue to have smear tests?  

Some women who have had a hysterectomy are still be at risk of developing abnormal cells and so should continue to have regular smear tests. If your womb was removed but you still have your cervix, you should continue to go for regular smears. If your womb and cervix were removed to prevent or treat cancer, you may still be asked to have a regular vaginal smear (vault smear). If your womb and cervix were removed for a benign (non-cancerous) condition, such as fibroids or heavy bleeding, you do not need to have any more smear tests. In general. if you do not have a cervix, then you do not need to attend for cervical screening.

During a smear test, some cells are taken from the cervix. These are sent to a laboratory for examination under a microscope, which is called cervical cytology. The best time (if possible) for a smear test to be taken is in the middle of the menstrual cycle, halfway between one period and the next. This enables the cytologist to examine the best possible specimen to achieve the best possible report.

Last Updated: 06 Feb 2009