Cervical smear tests aren't usually up there on the list of things we'd like to spend our time doing. But they are vital in the early detection of more pressing issues such as cervical cancer. So it's so important that when that letter lands on your doormat inviting you to book your screening, bite the bullet and call straight away. Don't give yourself time to think about it and make yourself more nervous—it's not as scary as it sounds, I swear. To help put your mind at ease, I've laid out everything you need to know about what happens during a smear test (and what results you might get back after too) so you can waltz right into that doctor's office without fear.
What is a smear test?
A cervical smear test is a screening test women are invited for to help prevent cervical cancer. It's not a test to diagnose cancer. The aim of the test is to pick up early changes in the cells of the cervix (the neck of the womb) that could lead to cancer in the future. Early detection is the most important step in cancer prevention. If precancerous cells are detected from a smear test, investigations and medical treatments can be started to halt the progression to cancer, which can be life-saving.
So smear tests can only be a good thing!
Who needs to have a smear test?
You'll first get invited for screening in the UK when you turn 25, but you'll then have a routine recall (repeat screening test) every three years until the age of 49. After than, they'll happen every five years until age 65, when screenings stop.
Women over 65 should still be screened if they have not had a cervical screening since the age of 50 or a recent screening has shown abnormal results. Cervical screenings won't stop due to age if a woman has had a previously abnormal test until she's had three screenings each with negative (or all-clear) results.
Many people ask me in GP practice why smear tests are only started from the age of 25 and not earlier. This decision was made by a panel of experts who looked at all the evidence. Their main reasons are:
1. Cervical cancer is extremely rare in women under 25 years of age.
2. Abnormal cervical screening test results are very common in women under the age of 25. Many of these changes seen revert back to normal without any treatment.
3. Cervical screening in these much younger women may do more harm than good. Women may be anxious and worried about abnormalities that eventually go away anyway. Also, there is the potential for harm to occur, as these women might end up being overtreated. This would mean removing cells from the cervix earlier than was needed, perhaps without waiting for the problems to go away by themselves.
What happens during a smear test?
Many women feel apprehensive leading up to smear test. Many worry it may be painful and complicated, or they can simply be embarrassed. As a GP who carries out smear tests and as a woman who has smear tests myself, I would like to take this opportunity to reassure that it's never a bad as you think! For those of you who have never had a smear test, this is what happens:
1. A smear test is carried out by nurse or doctor. They will insert a tiny plastic device called a speculum into the vagina. It's inserted closed and then gently opened so the practitioner can view the cervix.
2. A tiny sampling stick with a little brush on the end is to take a gentle "sweep" of the cells on the surface of the cervix. This is all that's needed for the smear to be taken.
3. The speculum is closed and gently removed in the closed position.
4. The brush is the inserted into a sterile pot and special solution to transport the sample to the lab.
5. Once in the lab, the cells are looked at under the microscope, and the findings are reported back to you and your GP.
What are they looking for?
The results can be as follows:
Abnormal, of which there are several grades or degrees of abnormality:
Mild abnormalities in the cells of the neck of the womb (cervix): mild dyskaryosis.
Moderate abnormalities in the cells of the cervix: moderate dyskaryosis.
Severe abnormalities in the cells of the cervix: severe dyskaryosis.
Possible cancer cells.
What is the HPV virus?
Ninety-nine in 100 cases of cervical cancer are positive for the virus HPV. If your test shows mild or borderline changes, it is automatically tested for HPV. If the test for HPV is negative, the chances of developing cervical cancer are extremely low.
Abnormal cells indicate that cancer may develop sometime in the future. About six women in 100 will have an abnormal result that requires further testing or treatment. Most of these changes will not lead to cervical cancer. All of those in the abnormal group sound scary, I know. But it highlights why the smear test is so important to detect early changes.
The results that are graded as "abnormal" are fast tracked through to a specialist clinic known as colposcopy for further investigations. In the colposcopy appointment abnormal cells are reassessed by a specialist doctor, and a treatment plan is decided which can involve freezing, burning, laser or cutting them away.
If you're called for colposcopy, don't panic! It's really really important for you to attend the appointment. It doesn't mean you have cancer. If you have any worries, contact your GP—they will be more than happy to discuss your results will you and explain the next steps to help keep your anxiety to minimum.
In short, remember: The test is simple, quick, mostly pain-free and really not embarrassing. Yes, the results may be confusing, so don't hesitate to discuss with your GP, and definitely never miss your smear test appointment if you're called for one. It's never as scary as you think!