LIFE

Cervical screening and smear tests

Last modified on Wednesday 20 January 2021

Cervical screening is the most effective way of preventing cervical cancer. But with 3,000 cases of cervical cancer still diagnosed in the UK each year, are you sure you're up to date with your smear tests?

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What is a smear test?

A smear test is an examination that is offered to women aged between 25-64 and is repeated every 3-5 years (depending on your age).

It involves taking a small sample of cells from your cervix (or 'neck of the womb') which are examined under a microscope to see if there are any changes.

Any unusual changes could, if left untreated, lead to cancer in the cervix. Early detection and treatment can prevent 75 per cent of cancers developing, although like any screening it will not always pick up abnormalities.

Who can get cervical cancer?

It's possible for women of all ages to develop cervical cancer, but the condition mainly affects sexually active women aged between 30 and 45. Cervical cancer is very rare in women under 25.

Signs and symptoms of cervical cancer

Cancer of the cervix often has no symptoms in its early stages, which is why it's so important to have regular smear tests.

If you do have symptoms, the most common is unusual vaginal bleeding, which can occur after sex, in between periods or after the menopause. This doesn't necessarily mean you have cervical cancer but it's a good idea to see your GP just to get checked out.

HPV and cervical cancer

There are over 100 different types of human papilloma virus (HPV). It is sometimes called the wart virus as some types of HPV cause genital warts. A number of HPV types are passed on from one person to another through sexual contact.

Many women will be infected with the HPV virus at some time during their lifetime. Often the virus causes no harm and goes away without treatment.

Some types of HPV can increase the risk of developing cervical cancer. Of the different types of HPV, types 16 and 18 cause about 7 out of 10 (70%) cancers of the cervix. Most of the remaining 30% of cervical cancers are associated with other high risk HPV types.

HPV is also a risk factor for other types of cancer including vaginal cancer, vulval cancer, anal cancer, cancer of the penis and mouth and oropharyngeal cancers.

The HPV vaccine is available in the UK to protect against types 16 and 18 and is offered to girls age 12-13 (Year 8). You can read more about this here .

How effective are smear tests?

Following the success of the NHS Cervical Screening Programme and the early detection of cell changes, the number of cervical cancer cases in the UK has reduced. Around 3,000 cases of cervical cancer are diagnosed in the UK each year. In the UK, just under 1,000 women die from cervical cancer every year.

What happens in a smear test?

A doctor or nurse inserts an instrument (a speculum) to open the woman's vagina and uses a brush to sweep around the cervix. If you've had a sweep at the end of your pregnancy before, this will be a doddle as it's quicker and less uncomfortable.

Some people feel anxious or embarrassed about having a smear test, and although it can be slightly uncomfortable, it is very quick. You can ask for a male or female practitioner to take your smear.

If you feel worried about having a smear test, please do speak to you nurse or doctor as they will be able to answer any questions or help you feel more reassured so that you feel able to have it.

You can have a smear test at your GP surgery, local family planning or well women clinic, or at a sexual health or GUM clinic.

Watch this video below to find out more about what cervical screening involves ...

When should I have a smear test?

It is best to have your smear test mid cycle – so about 14 days from the start or your last period. This is because it the doctor or nurse is likely to get the best possible sample of cells at this time.

If you are, or may be pregnant, it is best to speak to your practice nurse or doctor about having a smear. If you have had normal smear results in the past, they may recommend that you wait until about three months after you have had your baby.

Why aren't smear tests available for women under 25?

This is because changes to the cells in the cervix of young women are very normal, and abnormal results could lead to unnecessary treatment, which could have an impact on a women having a baby later in life.

Occasionally some women may experience unusual bleeding after sex or at other times – in which case it is a good idea to see your GP.

What does my cervical screening result mean?

The screening does not detect cancer. It picks up on unusual changes in the cervical cells.

You'll get a letter within 14 days of your smear test that will say it's either:

  • normal
  • inadequate
  • abnormal

If it's normal, you won't need another test until you get a letter sent to you (usually three to five years later depending on your age).

An inadequate result means that it couldn't get an accurate enough reading of the cells so you'll need to have another test done. This is usually done three months later. Some medications can cause changes to cells, for example for treatment for hormonal conditions or breast cancer, so it is important to tell the person who is taking the test if you are on any medication.

An abnormal result can be caused my many different factors. Depending on whether it's low-grade or high-grade, you'll have further tests done.

Very few women with an abnormal smear test result actually have cancer of the cervix.

CIN explained

Sometimes the abnormality may be due to changes in the squamous cells of the cervix. This is known as CIN, which stands for cervical intra-epithelial neoplasia. The screening report may refer to the changes as dyskaryosis.

These abnormal cells are not cancerous, but if left untreated they can sometimes go on to develop into a type of cancer of the cervix called squamous cell carcinoma.

As the cells can sometimes develop into cancer, changes to them are sometimes called pre-cancerous changes.

CIN is divided into grades, which describe how far the abnormal cells have gone into the surface layer of the cervix.

  • CIN 1 – Only one-third of the thickness of the surface layer of the cervix is affected.
  • CIN 2 – Two-thirds of the thickness of the surface layer of the cervix is affected.
  • CIN 3 – The full thickness of the surface layer of the cervix is affected.

With all three grades of CIN, often only a small part of the cervix is affected by abnormal changes.

It's important that CIN 2 and 3 is treated as soon as possible to ensure that it doesn't develop into cancerous cells.

Abnormal test result: what's the treatment?


If your test result is abnormal, you may need to have something called a colposcopy to identify the extent of abnormal cells and determine whether you need treatment.

This is similar to a smear test, but a specially trained doctor or nurse will use a colposcope (a bit like a magnifying glass) to look at the cells of your cervix, and a biopsy (a small sample) may be taken to examine more closely. Some people experience some bleeding for a couple of days after a colposcopy.

If the abnormal cells can't be seen clearly during the colposcopy, then further treatments such as a cone biopsy or LLETZ may be required (see below).

Abnormal test result: further treatment options

Cone Biopsy
The doctor takes a small cone shape sample of abnormal cells from the cervix to examine under a microscope. This may be done under local or general anaesthetic. This can show how much of the cervix is affected by abnormal cells (CIN 1, 2 or 3). A small piece of gaze is usually applied to the area, which is removed within 24 hours. Some women may also need a catheter to be inserted to drain urine following the procedure.

It is normal to have bleeding for a few days following the operation, and it's best to avoid sex or strenuous activity for a few weeks after, to allow your cervix to heal properly.

Sometimes a cone biopsy can cause the cervix to be weaker – which increases the risk of miscarriage in future pregnancies. This can be prevented by inserting a small stitch into the cervix during pregnancy.

Occasionally, the cervix can become tightly closed after a cone biopsy, which makes it difficult for sperm to pass and therefore more difficult to get pregnant. If you are still getting periods following the cone biopsy this means that the cervix is not completely closed.

Large loop excision of the transformation zone (LLETZ)
Also known as LEEP or diathermy loop biopsy, this procedure uses a small wire loop and an electrical current to cut away the affected area of tissue and seal the wound at the same time. You can read more here.


Abnormal cells in the cervix can also be treated with:
Laser therapy
A laser burns away the abnormal cells

Cold coagulation
A hot probe destroys the abnormal cells

Cryotherapy
A cold probe freezes away the abnormal cells

Hysterectomy
A hysterectomy| is an operation to remove the womb. It is sometimes done for persistent or severe CIN if women have other gynaecological problems and are past childbearing age, or don’t want to have more children. For women who've not yet had the menopause, the ovaries won’t be removed with the womb, so this treatment will not bring on an early menopause.

Post-treatment advice

You should contact your GP or the clinic where you had your treatment if:

  • The bleeding starts to get heavier
  • The discharge starts to smell, which can mean that you have an infection
  • You have any other concerns.