Cervical cancer is the fourth most common form of cancer in women. Although cervical screenings are registering increasing attendance lately, one in four women skips their smear test. A smear test can save your life, and it is the most effective way to prevent cervical cancer. During Cervical Cancer Prevention Awareness Week, Mr Andrew Pooley, Consultant Gynaecologist at New Victoria Hospital, kindly reminds all women about the importance of smear tests and provides us with important updates on early diagnosis.
Cervical cancer develops from abnormal cell growth in the cervix
Cervical cancer is the fourth most common tumour in women. It develops from abnormal cell growth in the cervix, the neck of the uterus that connects the external genitals to the womb.
About 2.300 new cases of cervical cancer are diagnosed every year in the UK. However, potentially almost all cervical cancers are preventable by attending screenings, especially in developed countries where prevention programs are easily accessible.
There are two types of cervical cancer:
- Squamous cell cervical cancer that appears in the outer layer of cervix cells
- Adenocarcinoma of the cervix that appears in the glandular cells of the cervix
98.9% of cervical cancers in the UK are caused by the Human Papilloma Virus
HPV is responsible for most cervical cancers in the UK. HPV is a common virus that can be found on the skin and mucosa (moist tissues), such as on the inside of the mouth, the cervix, in the genitals and the anus.
There are about 100 types of HPV, and only 13 of them are related to cancer.
About 80% of people get it in their lifetime. However, you might never know you had HPV as it doesn’t cause symptoms in most cases, and most people get rid of it as part of their normal immune response.
However, if your immune system can’t fight the virus, it may stay in your body for longer, leading to the possibility of developing abnormal cells.
Cervical cancer risk is higher in people who don’t attend cervical screenings regularly
A smear test can detect abnormal cells that can potentially turn into tumours.
Cervical cancer risk is estimated to be 1.7% among women in the UK who don’t attend screenings.
Other risk factors are related to a higher exposure to Papilloma Virus, such as being sexually active, giving birth at a younger age, the use of the contraceptive pill for over ten years, or a weak immune system.
Finally, pathologies like HIV and Lupus can compromise the ability of your antibodies to get rid of HPV.
A 2019 study published on Preventative Medicine reports an increased 1.3% incidence in cervical adenocarcinomas every year between 2002 and 2015 among the non-Hispanic white population, whereas it was stable among all other racial groups.
The study seems to suggest a correlation between cervical cancer and race.
However, the increasing incidence in non-Hispanic whites can be explained with better access to healthcare and over-diagnosis within this ethnic group.
A smear test can detect abnormal cells
Smear tests, or cervical screening, are not tests for cancer.
A smear test is an examination to detect the presence of High Risk HPV or abnormal cells in the cervix, but this doesn’t necessarily mean that they are cancerous.
If you are registered with a GP surgery and you are between 25 and 49 years old, you are invited by the NHS to book an appointment for your screening every three years, or every five years, if you are between 50 and 64 years old.
If you have limited time availability, you are experiencing symptoms or would like to have a consultation with a Specialist, you can book an appointment with one of our Private Consultant Gynaecologists.
How does a smear test work
Cervical screening is a minimally invasive examination to collect a sample of cells from your cervix.
If you book a smear test at New Victoria Hospital, it will be performed by a Gynaecologist.
- The Consultant will ask you to lay down on your back keeping your ankles together and spreading the knees apart
- They will insert a new, single-use speculum, a small plastic tool that allows the cervix to open and be visible
- They will then introduce a tiny brush, and will spin it around your cervix surface in order to collect the cells
- The brush is then removed, and the cell sample is placed in a liquid to preserve it and sent to the lab
- The Consultant removes the speculum, and the examination is concluded
Sometimes you can experience some discomfort during the screening, but the procedure is usually quick and painless.
It is important that you book your appointment after you had your period so that the bleeding doesn’t interfere with the results.
You should get your results usually within 4 days if you have your smear test done at New Victoria Hospital.
In December 2019, the national screening program for smears changed. Previously the smear was inspected for the presence of abnormal cells. Now the smear is tested for the presence of High Risk HPV which has been found to be a more accurate test in identifying potential abnormalities. If HPV is found then the smear is checked for the presence of abnormal cells. This change was made because being negative for HPV is a much stronger indicator of being very low risk for serious cervical disease.
The new system is much more precise than the previous one as there is a lower risk for false positives. Moreover, negative results are better predictors of a lower risk of HPV for the following three years, thus providing better peace of mind between smears.
Your smear test results can be negative for HPV, positive for HPV without cell abnormalities or positive with cell abnormalities
If your results come back negative, it means your cells are fine and you will be invited for the next screening in one, two or three years, depending on your age and condition.
If the results are positive with or without cell abnormalities, it means that the HPV has been detected, but this doesn’t mean you have cancer.
If your test is positive without cell abnormalities, you will be recommended to repeat the HPV test after a year, instead of three.
Colposcopy is required when abnormal cells are found
If cell abnormalities are found, a colposcopy is necessary to take a closer look at the cervix with a microscope.
A colposcopy is carried out in a similar way to a smear test, but the colposcopist applies a liquid to highlight the abnormal cells.
During a colposcopy, a biopsy is usually performed, with one to three small samples of your cervix tissue are taken for further lab test.
If your colposcopy result is abnormal, it means that the cell changes identified with the cervical screening are confirmed.
The most common abnormality found is cervical intraepithelial neoplasia (CIN) of which there are three levels. More rarely cervical glandular intraepithelial neoplasia (CGIN) is found.
These indicate changes in skin-like cells and glandular cells, respectively.
Your Gynaecologist might suggest having treatment straight away, or on a later visit. Abnormal cells are removed with an electrical excision (LLETZ), laser or cryocautery procedures with a very high chance that the abnormal area is fully treated and removed.
Regular cervical screenings are even more important after your colposcopy.
A smear test is the most effective way to prevent cervical cancer.
Symptoms to look out for:
- Bleeding in between menstruation or during and after sex
- Pain during sex
- Lower back pain
- Postmenopausal bleeding
- Unusual vaginal discharge
If you experience any symptoms, you should see your GP or your Gynaecologist as soon as possible.
If you would like to make an appointment with one of our Consultant Gynaecologists or Private GPs at New Victoria Hospital call 020 8949 9020 or book online.
