What is cervical screening or the "smear test"?
Cervical screening is a screening test that can pick up the presence of a high-risk HPV strain and abnormal cellular changes on your cervix. Abnormal cellular changes means that some of the cells on your cervix didn't develop the way they were expected to. Cervical intraepithelial neoplasia (or "CIN") is the term that tells your doctor that these cellular changes on your cervix have occurred. Now hold up! This doesn't mean straight away that you have cervical cancer but it does mean that these cells have the potential to turn into cancerous cells in the future. Another pause for the importance of screenings.
By detecting these cells at the early stage, your doctor can help you get the treatment option that you need.
Who needs to get cervical screenings?
Anyone who has a cervix should get regular cervical screenings. This includes women who have not had a hysterectomy (removal of the reproductive organs, including the cervix), transgender men, non-binary people, and intersex people who have a cervix. All individuals meeting these criteria between the ages of 25 and 64 years will be invited for a screening by the NHS, and this is an invitation you don't want to turn down. A common misconception is that “I’ve never had a sex with a man so I don’t need a smear test”. The virus is everywhere in our environment, so if you ever had any type of sex/intercourse/genital contact, it's recommended that you attend a screening. If you're uncertain about whether you should book a screening, you can use the flowchart below to help:
Jo's Cervical Cancer Trust, the NHS and Cancer Research UK have a wealth of resources for anyone who needs testing no matter your gender identity, as well as resources to cope with anxiety.
Does the screening hurt?
During a test, you will be laid on your back with your legs elevated. A smooth tool called a speculum will be inserted into the vagina, which allows a good view of the cervix. Some people find that part of the examination uncomfortable, but the speculum comes in a variety of sizes, and the one most appropriate for your body will be chosen to reduce discomfort as much as possible. Once there is a good view of the cervix, a small brush is inserted and sweeps the walls of the cervix to collect cells, the brush and speculum are removed, and the procedure is done. Once the doctor visualises your cervix, it normally only takes a few seconds to use the brush and collect the sample, and the entire test itself is usually over in 5 minutes.
Some people may get some spotting after the smear. People who have cervical ectropian (this is when the cells from inside the cervical canal grow on the outside of the cervix) may be more likely to experience discomfort or cramps from the stimulation of the cervix.
There are a few factors that may cause screening to be more uncomfortable than usual, such as:
- Vaginismus: sudden tightening of the vagina during any insertion
- FGM: Female genital mutilation
- Endometriosis: chronic scarring and inflammation can make the procedure more painful
- Cervical erosion: where cells from the cervix grow beyond the cervix
- Having a tilted cervix
During any test, you are in control. You can ask the test to be stopped at any time, you can lie in a more comfortable position, and you can ask for a different size speculum. You can also ask for a longer appointment if you’re particularly anxious, and have someone accompany you to the appointment.
The results take a few weeks to come back. In the UK, around 95% of women attending cervical screening will have a normal result. Abnormal results means that there may be some cells on your cervix that need to be investigated further. Those with abnormal results may be invited for a colposcopy appointment. During that appointment, if the doctor sees any abnormal areas, they may take a biopsy (tiny piece of tissue) to be sent to a lab for analysis.
Looking to the future
There have been incredible strides in cervical cancer research and treatment and prevention. The introduction of the HPV vaccine has been invaluable in prevention, with a study funded by Cancer Research UK stating that ‘the HPV immunisation programme has successfully almost eliminated cervical cancer in women born since Sept 1, 1995. Attending your smear test is currently the single most effective way of preventing cervical cancer.
There have also been breakthroughs in treatment of late stage, treatment-resistant cervical cancer. The HARE-40 clinical trial is currently underway, which is testing a vaccine that activates the immune system to kill cancers caused by HPV. If this trial is successful, it will give patients who have already tried every treatment option new hope in treating their cancer.
The proverb ‘an ounce of prevention is worth a pound of cure’ is used a lot when discussing medical conditions, and cervical cancer is one of the most applicable to this. The early stages typically show no symptoms, or symptoms which many may brush off, and, again, approximately 98.9% of cases are preventable. Attending cervical screenings is the best defence you have against cervical cancer.
Anyone with a cervix from the age of 25 is entitled to cervical screening, during which you should be respected, in control and comfortable. There is a lot of hope for the future, the HPV vaccine will drastically reduce future cases. However, you should still attend screenings, as HPV is not the only cause of cervical cancer!
- Estimates of the global burden of cervical cancer associated with HIV, Stelze et al, The Lancet. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30459-9/fulltext#:~:text=Women%20living%20with%20HIV%20have%20a%20substantially%20increased%20risk%20for,cancer%20are%20attributable%20to%20HIV.
- Oral Human Papillomavirus Infection in Children during the First 6 Years of Life, Finland. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920652/
- Let’s talk about it… sometimes smear tests are painful https://www.jostrust.org.uk/about-us/news-and-blog/blog/sometimes-smear-tests-are-painful
- Let's talk about...smear tests when you have endometriosis https://www.jostrust.org.uk/about-us/news-and-blog/blog/lets-talk-about-smear-tests-when-you-have-endometriosis
- Let's talk about... smear tests when you have a tilted cervix https://www.jostrust.org.uk/about-us/news-and-blog/blog/lets-talk-about-smear-tests-when-you-have-tilted-cervix
- Our cervical screening tips https://www.jostrust.org.uk/information/cervical-screening/cervical-screening-tips
- The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study https://www.sciencedirect.com/science/article/pii/S0140673621021784
- Trial of a new vaccine to treat incurable cancer expands to more UK sites https://www.southampton.ac.uk/ctu/news/2022/07/14-trial-of-vaccine-to-treat-incurable-cancer-expands-to-manchester.page
Article edited by Fiona Kennedy, MSc
Medically reviewed by Dr.Paulina Cecula