Cancer of the cervix1 is one of the most common cancers in women today, with around 900 related deaths each year in England alone. Most cases of cervical cancer are caused by certain strains of the human papilloma virus2, which are sexually transmitted and in fact are considered to be the most commonly sexually-transmitted virus in the world today. Other risk factors include a weakened immune system, having multiple sexual partners or a male partner who has had multiple partners, becoming sexually active at an early age, long-term use of contraceptive pills, smoking and poor diet.
By looking at a small amount of cells taken from the area during a smear test3, doctors have found it possible to detect early warning signs and offer preventative treatment. The Cancer Research Trust estimates that around 4,500 women's lives are saved per year by this cervical screening programme.
Do I Need To Be Tested?
All women between the ages of 25 (in Northern Ireland, Scotland and Wales the age limit is 20) and 65 who have ever been sexually active are advised to be tested regularly4. You will probably receive an invitation from your local health authority when your test is due. If you would like to ensure your test is done by a female doctor or nurse, ask — most GP surgeries are quite understanding about this. It is most advisable to book your test for just after your menstrual period finishes and never to have the test during it.
The test is carried out by a doctor or nurse trained in taking a smear test. To carry out the test, the tester will ask you to remove your clothes from the waist down and lie on the bed. You will be asked to draw your feet up to your bottom, allowing your knees to open, which will allow clear access for the examination. The tester will then insert a well lubricated instrument called a speculum into the vagina to hold it open. It is advisable to relax at this point, as this may feel a little uncomfortable. A bottle brush-like instrument is used to stroke cells from around the cervix5. This is then sealed in a tube and sent off to a lab for analysis. Your sample will be kept after testing for up to ten years for comparison with future samples as an extra way to detect changes and change rates. The test should take no more than a few minutes and you will be advised as to when and how you will receive the result.
What Happens Next?
When you receive your result, most likely by letter in the post, it will tell you what to do next, if anything. If no changes were found, you will be reminded when your next test is due. If there have been changes detected, what happens next will depend on the severity, though you will probably need to seen a gynaecologist.
On occasion, a second smear may be needed if the first was not conclusive for some reason; eg, if there were insufficent cells on the slide, blood or semen clouded the view, etc. It is also worth remembering that the person in the lab checking your test is a human being and mistakes can happen. Such instances would also require a repeat test.
If you are found to have early cell changes, known as dyskariosis, you will need to see a gynæcologist at the hospital. He or she will want to examine your cervix in more detail with a microscope-like device known as a colposcope. This is a painless exam carried out similarly to the smear test. This exam enables the doctor to confirm that there are in fact changes, and their degree. You may need more than one appointment with the colposcopy clinic, which may also take a small biopsy during the colposcope exam.
Treatment depends on how developed the cell changes are. Abnormal results are usually classified into three stages:
- CIN level 1 (mild dyskaryosis) — In this instance, you will either be asked to have a repeat smear in six months' time to check that the changes are still present or be invited for a colposcopy exam. These slight changes often return to normal by themselves. If they do not and the second smear is also abnormal, a colposcopy will definitely be required in order to decide if further action should be taken.
- CIN levels 2 and 3 (moderate to severe dyskariosis) — If you receive either of these results, you will be advised to have treatment to remove the abnormal cells after the result has been confirmed by colposcopy. There are a number of treatment options your doctor may choose. These include using a laser to burn away the affected cells, radiotherapy, or a cone biopsy where a cone-shaped area of the cervixin, including all affected cells, is cut out. Most of the available treatments are minor and usually done as day cases under local anaæsthetic, although cone biopsy may require an overnight stay and a general anæsthetic. You will usually only need to be treated once. However, more regular smear tests are usually required for a few years when monitoring after this kind of treatment.
- Carcinoma in situ — Level 3 cell changes are sometimes also known as carcinoma in situ. This means that although there are cancerous cells on the surface of the cervix, they have not yet begun to invade the tissue. These changes are usually treated in same way as other CIN 3 results and should not cause undue concern.
Please note that an abnormal smear test result, even one requiring surgical treatment, does not mean you have cancer. The test is an early warning system to detect and remove, if necessary, anything that could possibly lead to cancer later in your life.