A recent report in the British Journal of Cancer found that nearly 2,000 women’s lives are saved in England each year as a result of cervical screening; most commonly by identifying and treating pre-cancerous cells before they have a chance to develop. In England, cervical screening is offered to all women between the ages of 25 and 64. Those aged 25-49 are invited to a screening every three years and for those aged 50-64, every five years. Yet the report highlighted that hundreds more lives could be saved if all those eligible attended their screening appointments.
In a bid to increase awareness about the importance of getting tested, Wellbeing of Women, the charity that funds pioneering research into women’s reproductive health, approached one of their experts, Dr Emma Crosbie, Honorary Consultant Gynaecological Oncologist at the University of Manchester, to provide an overview of exactly what to expect.
What is a smear test?
A smear test detects early signs of cervical pre-cancer (changes that happen before cancer develops).
Why do I need one?
Regular smear tests prevent cervical cancer by detecting pre-cancerous changes that can be treated before they become cancer.
What does it involve?
A nurse or doctor takes your cervical smear. You will undress from the waist down in a private room. You will be asked to lie down on your back with your knees parted. A speculum will be placed gently inside your vagina. This is a hollow cylinder that parts the vagina to get a clear view of the cervix. A soft broom is then brushed against the cervix to collect some cells. The cells on the broom are shaken off into fluid preservative and sent off for analysis.
Does it hurt?
Having a smear test is not painful but it can be uncomfortable. It only takes a few minutes to do and any discomfort goes away straight afterwards.
What happens to the smear?
The cells are looked at under the microscope. This is called cytology. Most smear tests show normal cells. Sometimes the cells look abnormal in size or shape under the microscope. This is called dyskaryosis. The dyskaryosis is graded as mild, moderate or severe, depending on how abnormal the cells look.
What is HPV?
HPV is human papillomavirus. It is a very common virus that infects humans. There are over 100 types of HPV. Most do not cause serious problems. A few types – known as high risk types – are known to cause cervical cancer. If your smear test shows mildly abnormal cells, it will be tested for high risk HPV. If it is HPV negative, you do not need any treatment because your risk of cervical cancer is extremely low. If it is HPV positive, you will be referred for colposcopy.
What is colposcopy?
Colposcopy is a simple procedure carried out in a clinic at your local hospital. The nurse or doctor uses a colposcope to illuminate and magnify the view of your cervix. They may use different solutions on your cervix to help them check it is normal. If they see any abnormal cells, they will take a biopsy. This is a tiny piece of cervical tissue the size of a matchstick head. It will not hurt but it may be uncomfortable. The tissue will be sent for histology.
What is histology?
The small tissue sample will be looked at under the microscope. This will allow the pathologist to see whether or not there are any pre-cancerous cells present. Pre-cancerous cells are called cervical intraepithelial neoplasia (CIN) and these are graded as CIN1, 2 and 3.
Will I need treatment?
If your biopsy shows CIN2 or 3, there is a small chance that if these cells are left untreated they may progress to cancer. You will be offered treatment to remove these abnormal cells.
What treatment will I need?
Most abnormal cells are treated by Loop diathermy or Large Loop Excision of the Transformation Zone (LLETZ). Loop diathermy removes the abnormal cells using a thin loop of electrified wire. It is done using a local anaesthetic (injection to numb the cervix) in the clinic. It will not hurt any more than have a smear test. It will take about 10 minutes. Afterwards you may have some crampy pain and it is a good idea to take the rest of the day off work and rest at home. After that, you are fine to return to normal activities. You should avoid having sex, wearing tampons, having baths or swimming for about 3 weeks afterwards to reduce the risk of infection. You will have a mucky discharge for a few weeks but your period should come at the normal time.
This treatment is effective in nine out of ten women with abnormal cells. You will need a smear test in 6 months to make sure the abnormal cells have gone completely.
Can HPV be treated?
Treating the abnormal cells usually clears up the HPV infection too. There is a vaccine that is given to school aged girls that prevents HPV infection in the first place. Girls who have been vaccinated are less likely to develop abnormal smears but they should still go for their smear test when they are invited.
How can I reduce my risk of cervical cancer?
- Go for your smear test (it can save your life)
- Stop smoking (women who smoke are more likely to have abnormal smears, CIN and cervical cancer). For more information on quitting smoking, speak to your GP.
With sincere thanks to Mr Neal Ramchander and Dr Emma Crosbie, Senior Lecturer and Honorary Consultant Gynaecological Oncologist at the University of Manchester.
September is Gynaecological Cancer Awareness Month. Please follow the link to hear more about the remarkable work that Wellbeing of Women has been funding into this vital area of research.
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