The Cervical Smear

What is cervical screening?

  • Cervical screening is a test to check the health of the cervix, which is the lower part of the womb (often called the neck of the womb). The test is usually called a 'cervical smear'.
  • Cervical screening is not a test for diagnosing cervical cancer, but aims to prevent cancer from developing.
  • For most women, the test results do not show any abnormalities. However, for 1 in 10 women, the test result shows changes in the cells. These changes can be caused by many things.
  • Most of these changes will not lead to cancer, but some may develop into cancer if they are not treated.
  • Cervical screening saves over 1000 lives in the UK each year. However about 1500 women still die from cervical cancer in the UK each year.

Why me?

Cervical Screening Wales (CSW) invites women who live in Wales for a test every 3 years (if aged 25-49) or every 5 years (if aged 50-64). If you have had a hysterectomy or are over 65, you may not need to have the test and should ask your doctor or nurse for advice.

Many women who have never had intercourse are unsure if they need to have the test. You may find it helpful to read the CSW leaflet 'Should Women Who Are Virgins Have Cervical Smears?'.

Who will carry out my test?

A qualified doctor or nurse. Please ask when you make the appointment if you would prefer the test to be carried out by a woman, or would like someone with you. You can choose whether to have the test done at your own doctor’s or at any Well Woman or Family Planning Clinic. You should expect complete confidentiality and privacy, and have the right to refuse to have any non- essential staff, such as trainees, present.

Will I have to undress?

You will be asked to undress from the waist down, but if you wear a skirt you may not need to remove it.

What happens during the test?

  • The smear taker will ask you to lie down on a couch.
  • They will gently put a small instrument, called a speculum, into your vagina to hold it open.
  • They will wipe a sampler over the cervix to pick up a few of the cells.
  • They will preserve the cells and send them away to be examined under a microscope.
  • The test takes just a few minutes.

Does the test hurt?

You might feel some discomfort or pain - try to relax by taking slow, deep breaths as it may hurt more if you are tense. If it is painful, tell the doctor or nurse straight away, as they may be able to help.

Can I have sex before the test?

If you use a spermicide, a barrier method of contraception or a lubricant jelly, you should not use these for 24 hours before the test as they contain certain chemicals that might affect the test.

How will I get my result?

All women who live in Wales receive their test results by post. We aim to provide you with your result within 4 to 6 weeks of the test being taken, but sometimes it takes a little longer.

How reliable is cervical screening?

Regular cervical screening can prevent up to 75% of cancers developing, but like other screening tests it is not perfect. It does not always detect early cell changes that may lead to cancer. Abnormal cells in your sample might be missed because:

  • Sometimes they do not look much different from normal cells
  • There may be very few abnormal cells in the sample
  • The person reading your sample may miss the abnormality (this happens occasionally, no matter how experienced the reader is).

If you have any unusual symptoms such as bleeding after sex or between periods, you should see your doctor, even if you have had a recent negative test.

What does it mean if I am called back?

It might simply mean that your sample did not show up clearly and we need to take another test. This is called an ‘unsatisfactory result’, and does not mean that there is any abnormality in the sample. About 1 in 60 tests are unsatisfactory because:

  • There may not have been enough cervical cells in the sample to give an accurate assessment;
  • You may have an infection that needs to be treated before a good quality sample can be made;
  • The cervical cells in your sample may have been hidden by blood or mucus;
  • Your sample may not have been properly prepared; or
  • Your sample may have been damaged in transit.

On the other hand, your result could identify some small changes in the cells in the cervix. If abnormal changes (known as dyskaryosis) are detected, you will have what is called an 'abnormal result'. This is unlikely to be cancer. However, sometimes very rarely cancer will be found when an abnormal result is investigated further.

For more information about what an abnormal result means, you can read the CSW leaflet 'The Smear That Needs to be Repeated'.

Can anything be done about abnormal changes?

Yes. You may be asked to come back for more cervical screening tests, because the abnormal cells may return to normal by themselves. However, you may be asked to go to hospital for a further examination, which is called colposcopy.

Treatment, if it is needed, is a minor procedure, and is normally done in an out patient clinic, which means you do not have to stay overnight.

Can cervical screening prevent cancer?

The aim of the cervical screening programme is to prevent cancer. Regular screening is the best way to detect changes to the cervix early and prevent them developing into cancer. Cervical cancer is more common if you:

  • First had sex at an early age.
  • Smoke.
  • Do not use condoms.
  • Have had several sexual partners (or have had a sexual partner who has had several other partners).
  • Take immunosuppressant drugs (for example after an organ transplant).

If any of the above points apply to you, it is particularly important for you to have the test regularly but there is no need for you to be tested more often. However, if you are HIV-positive, you are advised to have smear tests every year.

Early detection and treatment can prevent cancer developing in over 80% of cases.

What happens to my test once it has been looked at?

The laboratory that looks at your sample will keep it for at least 10 years. They can then compare your latest test result with the ones that you have had before. This is to make sure that you get any treatment you may need. We may review all screening records, including your sample, as part of our aim to offer a quality service and to help increase the expertise of our specialist staff. If a review were to show that you should be cared for differently, we would contact you. We would offer you information about the review of your case if you wanted to know it. We may also use your sample for teaching or for research purposes. This would not use your name. If you are unhappy about this, please let your smear taker know.

Summary

To help you decide whether or not to come for cervical screening, the main benefits and difficulties of cervical screening are described below:

  • Regular cervical screening reduces the risk of developing cervical cancer.

  • Due to cervical screening, cervical cancer is now an uncommon disease in this country.

  • Cervical cancer rates have halved since the 1980s, largely due to most women having regular cervical screening.

  • Cervical screening by the NHS saves over 1000 lives each year.

  • Some women find having the test an unpleasant experience.

  • In 1 in 40 tests, the cells cannot be seen properly under the microscope and the test must be taken again.

  • The test can pick up minor abnormalities in cervical cells which would have cleared up on their own and women would never have known about them if they had not been for screening. It is not yet clear which minor abnormalities would develop into cancer and which would not. Many worry when an abnormality is found.

  • Cervical screening does not pick up every abnormality of the cervix.

  • Regular cervical screening can prevent about 75% of cervical cancers developing, but it does not prevent every case. It is important therefore that you report any unusual symptoms to your GP.

[Version eCSW13v3 - edited]