Cervical screening – what every woman should know

This week (11th - 17th June) is Cervical Screening Awareness Week where #TeamEve encourage all women to attend their cervical screening (or smear tests as they're commonly referred to) when invited. Especially in light of uptake figures demonstrating that there has been a sharp decline in women attending their cervical screening over the past few years.

That's why we've asked consultant gynaecologist and gynaecological oncologist Dr Adeola Olaitan, University College London Hospital, to tell us what we all need to know about cervical screening, the outcomes and to dispel a few myths along the way.

The cervical screening program was developed to protect women against cervical cancer. This is possible because before cancer develops, most women will have pre-cancerous changes on the cervix which cause no symptoms and if undetected and untreated, put women at risk of cervical cancer. Detection and treatment significantly reduce the risk of cancer.

All women from age 25 to 65, registered with a GP are invited to have cervical screening (smear test) at regular intervals. Smears work by collecting cells from the surface of the cervix to be analysed in the lab.

It is important to understand that a smear is a screening test, and not a diagnostic test. In other words a normal result means there is unlikely to be a problem.

What to expect from your screening results:

There are a number of possible smear results:

  1. Normal: over 90% of women will have this outcome. This means that it is highly unlikely that there are abnormal cells on the cervix. You will be asked to attend for a smear in three or five years depending on your age.
  2. Inadequate: This means insufficient cells were collected for analysis and the advice would be to repeat the smear in three months’ time.
  3. Low Grade: This includes borderline and mild dyskaryosis (aka abnormal nucleus or the central bit of the cell). The vast majority of women with this outcome will have no significant problems. About 20% will have a more significant abnormality and these are women who are currently infected with the High Risk Human Papilloma Virus (HPV). In order to identify these women, the lab will do a test for HPV on the cervical smear sample. Women who are HPV positive will be referred for a colposcopy (more details below). Women who do not have HPV infection will be asked to attend for a smear in three or five years.
  4. High Grade: Moderate or severe dyskaryosis. Women with this smear report are likely to have more cancerous changes that need treatment and thus are referred directly to colposcopy without the need for HPV testing.
  5. Invasive disease: The screening system was developed to prevent cancer, not to detect it but sometimes, very rarely, cancerous cells can be detected on a smear. The woman will be referred urgently to the gynaecological cancer specialists.

What is a colposcopy?

Colposcopy is the process of viewing the cervix with magnifying binoculars under a strong light. This gives the Colposcopist who may be a nurse or a doctor the opportunity to examine the cervix, determine if there are abnormal areas and, if indicated, take biopsies (samples). The biopsy is sent to the lab to be analysed so that a diagnosis can be made.

The possible outcomes at colposcopy are:

  1. Normal cervix: No abnormality detected. This is more likely in women with low grade smears. You may be asked to return to colposcopy in six months for confirmatory tests.
  2. Low grade disease: (Cervical Intraepithelial Neoplasia (CIN) grade1) in most cases this resolves spontaneously and no treatment is required but you will be kept under surveillance until the HPV infection clears up. Resolution of HPV infection requires a healthy immune system and the lifestyle alterations you can make to ensure this include:
    1. Stop smoking
    2. Eat a healthy diet
    3. Take regular exercise
  3. High grade disease (CIN2-3): This has a high chance of progressing to cancer if untreated and in most cases we would recommend treatment. Treatment is usually by an outpatient procedure called Loop Excision of the Transformation Zone (LETZ) in which a small electrical device is used to remove the tiny area of the cervix where abnormal cells arise. It is usually done under local anaesthetic. 95% of women require only one treatment so it is safe and effective. The cervix heals well and in the majority of cases there will be no distortion or scaring. However no treatment is without side effects.

The side effects of LETZ include:

  1. Bleeding: This can go on for up to a month and tampons and sex should be avoided until the bleeding stops to reduce the risk of infection.
  2. Infection: the LETZ procedure leaves a raw area on the cervix which is vulnerable to infection while it heals. Avoiding sex and tampons reduce the risk. However if the bleeding becomes heavy and smelly or you develop a discharge you should seek help as you may need to start a course on antibiotics.
  3. Cervical incompetence: The cervix can become weak after a LETZ procedure. This may manifest in pregnancy as under the weight of the growing pregnancy, the cervix can start to shorten and open increasing the risk of miscarriage or premature labour. You must tell your midwife or obstetrician if you have had a LETZ as they can monitor your cervix and if it appears weak, and insert a stitch to reduce the risk of miscarriage.
  4. Cervical Stenosis: LETZ procedure can lead to scaring of the cervix which might the canal get blocked. This may mean that menstrual blood cannot be released and a procedure called cervical dilation may be required. In addition, the cervix may not open (dilate) in labour, increasing the risk of a Caesarean section.

These complications are uncommon and have to be balanced against the risk of cervical cancer. These conservative options may not be available if a woman develops a cancer which is why screening is so important.

That’s why ladies, #TeamEve will always implore you to attend your cervical screening appointment when invited. And if you’re worried about attending your cervical screening for whatever reason, you can talk to your doctor or the nurse when booking your appointment. Alternatively, if you didn’t want to talk to them, but would rather speak with a a nurse-led service, please contact The Eve Appeal’s Ask Eve information service on 0808 802 0019 – which is free to call from landlines and mobile phones – or get in touch via email nurse@eveappeal.org.uk