We asked our medical expert, Dr Susanne Unsworth, to prepare a detailed guide on cervical screening procedures.
What Is cervical screening?
Cervical screening often referred to as a smear test, is a test designed to identify someone who is at a higher risk of developing cervical cancer. The test involves taking a small sample of cells from the cervix. The sample is then tested for the presence of high-risk human papilloma virus (HPV). High-risk HPV has been shown to be responsible for more than 90% of cell changes in the cervix that lead to cervical cancer, which is why testing for it now makes up a big part of the screening test. If the test is positive for the presence of HPV, the sample is then further assessed to look for any changes in the cells themselves.
The screening test is not trying to diagnose cancer itself but is done to identify early changes that can lead to cancer if left untreated. If these changes are found, they can be monitored or treated, which will prevent cervical cancer from developing. Smear test has been estimated to prevent up to 75% of all cervical cancers, although it has been suggested that it could prevent 83% of deaths from cervical cancer if everyone attended when invited.
Take-up for cervical screening has sadly been in decline and is currently at its lowest rate for over 20 years. It has been estimated around one in four women failed to attend their cervical screening when invited. The pandemic has contributed to reduced access to smear tests, but it is clear that uptake was on a decline well before the pandemic and has unfortunately been reducing year-on-year for the last decade stop. One of the biggest reasons for failure to attend is a lack of understanding and knowledge about the test itself and fear of what is actually involved.
Who Is Invited for Cervical Screening?
In the UK, the NHS Cervical Screening Program was introduced in 1988. In the current program, all women 25 to 64 are invited to attend the cervical screening: those aged 25 to 49 are invited every three years, and those aged 50 to 64 are invited every five years. Screening is also available to anyone in this age range who has a cervix, including trans men and non-binary people. The screening will end when someone reaches the age of 65, and their most recent screening test result is negative.
What Happens When You Attend a Test?
Cervical screening generally takes place at a GP surgery, sexual health clinic or specialist clinic, with the test usually performed by either a nurse or doctor. The test involves taking a small sample of cells from the cervix using a soft brush. The brush is then placed into a special pot containing liquid which is then sent to the cervical screening laboratories for assessment. (In the past, the sample was collected using a small spatula and the cells were ‘smeared’ onto a slide before being sent away for assessment: this is where the term ‘smear test’ comes from).
The whole appointment may last around 20 minutes, but the actual test itself will only take 2-3 minutes to perform. The doctor or nurse will explain the test to you and then give you some privacy to get yourself ready. This will involve undressing from the waist down and lying on an examination couch. You will be given a clean paper sheet to cover your lower half. The usual position will require you to lie on your back with your knees bent, placing your feet together and knees apart.
The first part of the test involves using a speculum – this is a cylinder-shaped piece of equipment that is gently inserted into the vagina and opened in order to see the cervix. Next, a small soft brush is gently rotated over the surface of the cervix to pick up a number of cells. The cells picked up by the brush are then placed into a special pot containing a liquid which allows them to be safely transported to the laboratory for testing. The speculum is then gently removed, and you can get dressed again – the test is over!
For most women, the test is completely painless. Occasionally some women can find the use of a speculum uncomfortable. This is more common if they are very anxious about the test or experiencing other issues, such as vaginal dryness symptoms as a consequence of menopause. If this is the case, speaking to your doctor or nurse about this ahead of the appointment can often mean things can be done to make the test more comfortable for you.
What Happens After the Test?
After your test, your sample will be sent to the cervical screening laboratory for further assessment, and you will receive your results in the post. In England, Scotland and Wales, the sample is first tested for the presence of high-risk human papilloma virus. This is known as HPV primary screening.
If your sample test is negative for the presence of HPV, it means you are very unlikely to develop any cell changes that can lead to cervical cancer. Therefore, no further tests are performed on your sample – you will just receive a letter stating your test was negative, and you will be invited again for a smear in another year or so, depending on your age.
If your sample test is positive for the presence of HPV, a further assessment of your specimen takes place. The cells that were collected during the test are looked at under a microscope to see if any changes have started to develop. If the cells look normal, you will be invited back after one year for a repeat screening test. If cell changes are found, you will likely be invited to have a more detailed assessment in a colposcopy clinic – this is where the cervix is examined more closely with a camera.
Frequent tests and doctor appointments can help you prevent any health issues or early recognize the risks, to start treatment as soon as possible. Most of the time, it’s enough to get checked once a year, so it can be planned and won’t take too much time, but it can help you stay healthy.