What is a smear test?

Cervical screening and why it is important

Introduction

Cervical cancer can often go undetected for a considerable length of time.  The reason for this is that the disease often does not display symptoms and after all, we can’t see our cervix! The longer that any form of cancer goes undetected, the greater the risk the disease will pose to our health and can ultimately result in death if treatment is not given early enough.

It is for this reason that having regular cervical screening is so important.

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What is cervical screening?

The term ‘screening’ means that early signs of disease are being looked for before any symptoms materialise. If early signs of more serious disease are found then it is likely that the disease can be treated more successfully as it has been caught early and the disease has not been given the chance to develop to a more dangerous stage.

In the case of cervical screening, we are looking for changes in the cells that cover the cervix or neck of the uterus where cancer can develop. During the smear test, a sample of cells is removed from the cervix which is then checked for the presence of high-risk HPV (human papillomavirus or wart virus) which can cause changes to the cells of the cervix. If there are no signs of the high-risk HPV then no further tests are required, If HPV is found then the cells will be checked for any abnormal changes. If abnormal precancerous cells are found here then it can be treated and so prevent cancer from developing. This is a highly effective method of preventing cancer and is believed to save approximately 4500 lives every year in England alone.

This test is also known as a smear test in England and a pap smear in the US.

 

What is HPV?

HPV is the most common sexually transmitted disease; there are many types of human papillomavirus that cause the disease and some of these types can cause health problems including genital warts and cancers.

 

How is HPV transmitted?

HPV can be contracted most commonly by having anal or vaginal sex with someone who is carrying the disease; however, HPV can be transmitted from any skin to skin contact of the genital area, oral sex, or sharing sex toys.

 

Who is at risk of contracting cervical cancer?

Provided you have a cervix and have had any kind of sexual contact with a man or woman, it is possible to get cervical cancer;  this is because 99% of cervical cancers are caused by infection with high-risk human papillomaviruses.

It is still possible to contract cervical cancer even if:

  • You have had the HPV vaccine as it does not protect from all types of HPV so you may still catch a high-risk type
  • You have only had one sexual partner as you can contract HPV the first time you have sex
  • You have had the same partner or have not had sex for a long time.  It is possible that HPV has been in your system for a long time without your realising it.
  • You’re lesbian or bisexual as any form of sexual contact can result in HPV being passed on
  • Trans men who have had a full hysterectomy but the cervix has not been removed should still have cervical screening as it is still possible that they could contract cancer of the cervix
  • If you are a woman who has also had a hysterectomy but the cervix is still intact it is important that you are still regularly screened

 

What happens during a smear test?

A smear test is usually carried out between periods; it is usual that a female nurse or doctor will carry out the test.  They will ask you to undress from the waist down but if you are likely to become embarrassed then wearing a long loose skirt may help.   You may also be given a piece of tissue to cover yourself

You will be asked to lie either on your back or on your side if it is more comfortable, place your feet together then allow your knees to fall apart. The practitioner will then insert a plastic speculum into the vagina. This usually doesn’t hurt but if you are tense it may be uncomfortable so try to relax as much as possible; taking a few deep breaths may help. A small brush is then used to remove a few cells from your cervix and the cells will then be transferred to a pot which will be sent to the laboratory for testing.

 

What happens if the result shows the presence of abnormal cells?                 

An abnormal result doesn’t necessarily mean that you have cancer but may mean one of the following things:

  • You have HPV but your cells appear normal
  • You have HPV but there are borderline or slight changes to the cells of the cervix
  • You have HPV and moderate or severe changes in the cells

If there are any changes in the cells this is known as dyskaryosis and the changes may go away on their own but it is also possible that they could develop into cancerous cells.

 

Evidence of HPV but no changes in the cells

If the cells are still normal despite the fact that HPV is present it is likely that you will be invited back for another smear test in a year's time. This second test is carried out to see if your immune system has eradicated the HPV infection. If the infection is still evident then the risk of developing abnormal skills increases; the test will be repeated in another year.

 

Evidence of HPV with borderline or slight changes in the cells

If there are borderline changes in the cells then more tests will be required.  Mild changes rarely develop into cancer and often return to normal; they will still need to be checked.  The extra test that will be needed is a colposcopy which is where a camera is placed into the vagina;  this enables the doctor to examine the area more thoroughly.  

 

Evidence of HPV and moderate or severe changes in the cells

Even if the results say moderate or severe changes have occurred in the cervical cells it is still most unlikely that cancer has developed in the cervix.  However, as these cells are less likely to return to normal on their own it is likely that treatment will be needed

 

Treating abnormal cervical cells

Different treatments are available depending on whether the abnormal cells need to be destroyed or whether the area of the cervix which if affected needs to be removed.

In the case of moderate or severe changes to the cells, a decision will be made during the colposcopy as to whether there is an area of the cervix that looks abnormal and so required that a biopsy be taken.  The sample of tissue is then sent to the laboratory for examination.  If the biopsy tests indicate that the cells need to be destroyed or removed, this can be done in a procedure known as loop excision or loop diathermy whereby an electrified wire loop is used to cut through and remove the area affected.

Other treatments that may be used include cryotherapy which involves freezing to remove the tissue,  cold coagulation which uses a heated probe for the removal, or laser therapy.

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