Preventing Cervical Cancer: Your Guide to Cervical Smears

By: Dr Danielle Robinson

Reviewed by: Dr Rose Abbott

Cervical cancer is the most common cancer in women under 35, but nearly two-thirds of women are not aware of this fact according to research conducted by Jo's Cervical Cancer Trust.

Most worrying of all is the huge education gap. Over 70 % of 25-29 year olds surveyed were not aware that cervical smears reduce the risk of them getting cervical cancer. Screening provides the best available prevention as it can protect against three out of four cases of cervical cancer.

Their study also found that young women avoid cervical smears because of embarrassment about their body shape (35%), the look of their vulva (34%), or about vaginal smells (38%). A third also agreed that they wouldn’t go to a screening if they hadn’t shaved or waxed their bikini area. More than 75% of eligible women attended a cervical smear in 2011, but attendance has been falling every year since.

Currently, around 5,000 lives are saved each year, but if screening rates keep falling, this number will, too. So if you’re concerned about getting a smear or just want to know more about it, we have created this guide to cervical smears.

What is a cervical smear and when will I be offered this?

A cervical smear is a screening test that is offered to all women with a cervix between the ages of 25 and 64 in the UK. It is a test to check a small sample of cells taken from the cervix which is the opening at the top of the vagina that connects to the womb. The smear sample is sent to the laboratory where it is checked for any signs of precancerous cells, early cancer changes or potential risk (through checking for HPV). In England and Northern Ireland, you are invited to be screened every 3 years until the age of 50. Once you turn 50, you’ll be invited for your smear every 5 years to the age of 65 years. Scotland and Wales recently changed their guidance and women are now invited for a smear every 5 years from the age of 25.

What does the procedure involve?

A cervical smear involves an examination with a plastic or metal device called a speculum. The speculum is shaped like a duck's beak and will be gently inserted into your vagina. It might be cold, but it shouldn’t be painful, so if you experience discomfort, let the nurse or doctor know.

The speculum is then opened up inside the vagina so that the doctor or nurse can see the neck of your womb (your cervix). A small flexible brush is then used to take a sample of the cells around your cervix. These cells are then transferred into a special pot and sent to the local laboratory for processing. It usually only takes around 5 minutes, from start to finish, to do your smear.

I am embarrassed about someone seeing me bare below the waist, do I really need to get this done?

It is normal to feel anxious about attending your smear. It may help to remind yourself that the clinician who is doing your smear will have likely examined hundreds of other women before you. He or she will be so focused on doing the procedure correctly, ensuring an adequate sample and checking that your cervix looks healthy, that they will not notice if you are wearing odd socks, have not shaved your legs or whether you have or have not shaved your pubic hair.

As clinicians, examining the genital and other sensitive areas is just part of our job. We really do just view the genital area as another part of the body – it is no different to examining an arm or hand to us. For your comfort, you will be given a modesty sheet to cover yourself, and the clinician will only expose the area needed for the examination for as short a time as possible. You will be able to undress and dress behind a curtain, also.

It’s important to point out that attending for a smear could save your life – that is surely worth just a few minutes of feeling slightly embarrassed or uncomfortable.

For some people, intimate examinations such as a smear can be triggering if there has been previous physical trauma and or abuse. If you feel this might be an issue for you, you can speak to your GP or nurse about how you feel before the procedure or ask for a double appointment to allow for more time and support for this.

Why am I unable to get a smear before age 25?

Smears are not offered until you turn 25 because the cells around your cervix are still maturing. Immature cells in the cervix can resemble abnormal cells and lead to an abnormal smear result. Most of the time, these immature cells return to normal without having to do anything. If they showed up during a smear, however, further investigation would be needed just to make sure they’re immature and not irregular. And by “further investigation”, we mean you would have to go to the hospital for a colposcopy. That is an invasive gynaecological examination that can often involve. taking large biopsies from your cervix. This has the potential to damage the cervix, increasing the risk of miscarriage and premature babies later in life.

In other words, if smears were done in women under the age of 25, thousands of women would end up going through the colposcopy process unnecessarily, leading to further problems later down the line when trying to conceive or during pregnancy.

Moreover, the risk of abnormal cells turning into cancer just isn’t as high in women under the age of 25. Research has shown that to pick up one case of cervical cancer in the 20-24 age demographic, 12,500-40,000 women aged 20-24 would need to be screened, and around 900 women would go through unnecessary treatments and colposcopy. All to catch one single case.

So does that mean smears screen for cancer?

In short, no, cervical smears do not pick up cervical cancer – they aim to pick up abnormal changes in the cells of the cervix before they become cancerous. Smears therefore aim to prevent cervical cancer and are a screening tool, not a tool for diagnosis.

If women have symptoms that could potentially suggest an abnormality of the cervix, they should be examined and potentially referred to colposcopy for further tests. A smear is not recommended in women with abnormal symptoms if they are not due a smear - it is a screening tool for asymptomatic patients. Symptoms that can suggest an abnormality of the cervix are:

• Bleeding after sex

• Bleeding between periods

• Unexpected bleeding when on contraception

• New pain during sex.

Speak to a doctor or nurse if you are experiencing any of these symptoms.

Where can I book my smear test?

You can have a cervical smear test at your GP practice or local sexual health clinic.

How do I get my result?

Your results will be sent to you in a letter to your home address. Make sure the person doing your smear has your correct address to avoid any delays in receiving your result. Results are sent from the national screening programme team, but if you do not receive a letter within a couple of months of having your test, you can contact the clinic who did the smear for an update. It usually only takes between 2 – 6 weeks to get your smear result, but there are currently long delays related to coronavirus. It can now take up to 12 weeks to get your result.

What does my smear result mean?

England, Scotland and Wales now use a test called ‘HPV primary screening’ during cervical screening. Northern Ireland currently uses a test called cytology (which we used to use in the rest of the UK), but will likely also switch to HPV primary screening in future.

HPV primary screening means your smear sample will initially be tested for a virus called HPV (Human Papilloma Virus). If your sample is negative for HPV, nothing else needs to be done and you will just be invited for another smear in 3 years (5 years if you are over age 50 or live in Scotland or Wales). If your sample is positive for HPV, the cells in your smear sample will then be analysed under a microscope. The result and outcome will depend on the appearance of the cells under the microscope. Please see the table below which outlines the result options.

Please try not to worry if your result does show that you are HPV positive. HPV is a virus that most sexually active people come into contact with at some point in their lives. It does not cause any problems for the majority of people and can often go away without treatment. We have written a separate article which explains HPV in more detail – you can read it here. Information about colposcopy is written further down in this article.

In Northern Ireland cytology tests are still used for cervical smears. This means you will get a slightly different result. In Northern Ireland, you are only tested for HPV if there are any abnormal changes to the cells on your cervix. See the table below for results in Northern Ireland.

Will smears in England and Northern Ireland also change to every 5 years instead of 3 yearly?

Most likely, yes, smears will change to every 5 years throughout the UK. This is not a cost-saving exercise but is due to the change in the way that cervical smears are now processed, as explained above. The change from cytology examination to primary HPV screening has been proven to be very effective. It takes time between getting HPV and developing precancerous cell changes, so if you are HPV negative at the time of a smear, you are extremely unlikely to develop all of these changes before the next screening in five years’ time.

In addition to all of this, HPV vaccination is now also offered to teenagers at school. This vaccination programme is significantly reducing the number of high-risk HPV positive cases and therefore abnormal cervical cells. This means that the prevalence of cervical cancer is going to become lower and lower in the UK - an amazing achievement in our lifetime.

Should I still go for a smear even if I have already had the HPV vaccine?

Yes - it is recommended by the NHS to have cervical screening with a smear whether you have had an HPV vaccination or not. This is because even if you have been vaccinated against HPV you are not protected against all types of HPV so are still at risk of cervical cancer.

What is colposcopy?

If you do need to have further investigation due to your smear results, you may well find yourself booking in for a colposcopy, as mentioned above. So what does all that mean?

The colposcopy clinic is usually based within the gynaecology department of your local hospital. A colposcopy is a test to take a closer look at your cervix if there are any concerns about the appearance of your cervix or abnormal cells are identified at the time of your smear.

During colposcopy, a speculum is inserted into your vagina and a microscope is then used to look at your cervix in greater detail. The microscope stays outside your body. A small sample of cells may be taken from your cervix for testing. This is called a biopsy. Colposcopy can feel a bit uncomfortable but should not be very painful. Depending on the appearance of your cervix or results of your biopsy, you may need further treatment to your cervix. The doctor or nurse will explain this further and gain your consent before proceeding however.

Real Life Story

Read more about our founder Caitlin Gould's personal experience with abnormal cells found during a smear test. Women's Health Stories: HPV and preventing Cervical Cancer (kensahealth.co.uk)

We hope this article has helped to explain cervical smears in more detail. For further information about HPV please have a read of the specific HPV article which can be found by clicking here.

Useful links:

Jo’s Cervical Screening Trust - Research -

https://www.jostrust.org.uk/about-us/our-research-and-policy-work/our-research

World Health Organisation - Cervical cancer -

https://www.who.int/news-room/fact-sheets/detail/cervical-cancer

NHS - HPV vaccine -

https://www.nhs.uk/conditions/vaccinations/hpv-human-papillomavirus-vaccine/

NHS - Cervical Screening - Why it is important

https://www.nhs.uk/conditions/cervical-screening/why-its-important/