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Scenario

Katie Latimer has come into the pharmacy to talk to technician Vicky.

 “I’ve been called for my first smear test but I think I’ll have my period when the appointment is booked. Does it matter?” asks Katie. “Also, I wondered why it has taken this long for me to have my first smear. Jake and I have been together since I was 19, and I thought your risk increased if you were sexually active. Mind you, I’ve not had anything that suggests a problem. But then isn’t cervical cancer one of those ‘silent killers’?”

Answer

Katie should try to rearrange her appointment, as cervical cytology – often referred to as a smear test – requires enough cells from the neck of the uterus to be collected and examined under a microscope in order to see if any are abnormal and potentially cancerous. The general advice is for women to book an appointment for around 10-14 days after the first day of their period, and to avoid sexual intercourse and any vaginal products for 48 hours before the test so that the sample is as clear as possible.

Under the NHS Cervical Screening Programme, all women aged 25 to 64 in the UK who are registered with a GP automatically receive a screening invitation letter at the appropriate time. The reason that women younger than this are not called is not only because cervical cancer is extremely rare in the under 25s, but also due to the fact that cervical cell changes are very common in this age group. This means there is a high chance of an abnormal result, which can cause anxiety and increases the chance of further treatment, which is not usually necessary because the changes to the cells usually resolve spontaneously but also, in turn, increases the risk of the women experiencing premature birth later in life.

The most common sign of cervical cancer is abnormal vaginal bleeding, though this is more commonly due to another issue such as a cervical erosion which stems from changing hormone levels, is harmless, and usually gets better without any treatment. Other possible cancer symptoms are discomfort during sex, pelvic pain and unpleasant vaginal discharge, though, again, these may be the result of another condition. In many cases, the lone sign of early-stage cervical cancer is cell changes, which can only be picked up by screening.

The bigger picture

Cervical screening is an effective way of reducing the incidence and mortality of cervical cancer: in the UK, it is believed to save around 5,000 lives each year, and prevents some 80 per cent of abnormal results from developing into cancer. It is offered every three years to women aged 25 to 49, and every five years to 50-64 year olds. Women outside these age bands usually only undergo testing if they have symptoms or have recently had an abnormal result.

The vast majority of cervical cancer cases result from infection with the human papillomavirus (HPV) – though it is important to note that only a minority of HPV infections lead to cancer. Other risk factors include smoking, having a compromised immune system, plus anything that increases the risk of exposure to HPV, such as being sexually active and/or giving birth at a young age, having a high number of sexual partners, giving birth to many children and long term use of the contraceptive pill.

If the smear test reveals mild abnormalities – known as dyskaryosis – the sample is tested for HPV. If this isn’t found, the women’s risk of developing cervical cancer before the next routine screening test is considered very low and no action is taken. If HPV is found, or if the dyskaryosis is moderate or severe, the woman is asked to return for a more in-depth examination of the cervix called a colposcopy.

Extend your learning

• Should pregnant women have smear tests? What about those who have had a hysterectomy, are in a same sex relationship or aren’t sexually active? Find out the answers via HSC 
• There is a school of thought that not screening under 25s for cervical cancer is solely about saving the NHS money. Read more via Public Health England
• Could you explain to someone who has been told she needs a colposcopy exactly what the procedure involves? If not, have a look at the information provided by Jo's Trust.