The words “smear”, “pap test” and “cervical screening” can strike dread in some, and nonchalance in others. But it is important, and I’d highly recommend attending screenings when you’re due as it’s not often we get the chance to be on top of possible cell changes that can, in some instances, lead to cancer. That said, I’m also very much of the opinion that this is a personal choice; it is your body and it is up to you whether you attend, and, should abnormal cells need to be dealt with, whether you go ahead with any treatment. There are reasons for and against and only you can make the decision.
In the UK, the age of screening starts at 25, which has been hotly debated. Women under 25, who report gynaecological symptoms, are all too often overlooked for a smear because they’re deemed to be too young. Utterly ridiculous. After 25, you get a letter every 3 years thereafter to return for another test to see whether there have been any changes during that time. When you’re aged 50 – 64, this extends to every 5 years. For women over 65, only those who have had an abnormal result or who haven’t had a screening since 50, will be offered the test.
[ The Screening ]
When you are due a screening test, you will receive a letter asking you to call your GP to make an appointment. It’s suggested you try to have the test done in the middle of your menstrual cycle, ie. roughly 2 weeks from the start of your last period. The test itself is pretty quick and is regarded as being relatively painless and straightforward. This does, however, vary between women. Your pain threshold is one factor, but there are also issues around where the cervix lies (ie. sometimes it can tilt backwards and make screening difficult, and in some cases women are asked to return for another go another day), pelvic floor dysfunction or implanted mesh etc can also affect the process. Some women find the test a breeze and hardly notice it has been done; a minority may find it uncomfortable or painful.
The test looks at any indication of HPV and cell changes, with the idea being that removing severely abnormal cells can help prevent them turning cancerous in future. The HPV virus sounds worse and more rare than the reality of it: nearly all sexually active men and women will have it at some point in their lives. This virus can cause cell changes (which may thus lead to cancer), so even though that may not be the cause in each case, it’s another reason to consider a smear. Of course, the smear test itself isn’t 100% accurate and sadly doesn’t detect all changes or cancers.
I won’t go in to the ins and outs of the procedure, but should you want to know more about it and prepare yourself or answer some questions you may have, Jo’s Trust has a great article on it here.
My first smear at 25 was fine, no problem whatsoever. Second time around at 28 and I had to return twice for the pap, and twice afterwards for treatment. It was very painful – eye-wateringly so – but I have other issues going on that could account for this. I then ended up having to have the treatment under general anaesthetic, which is only done in a limited number of cases, but I was grateful to have this option so that treatment could go ahead.
[ Results & What They Mean ]
Results in the UK via the NHS can take between 2-6 weeks. Most women will receive a “negative” and find that no abnormalities have been found. For 1 in 20 women, a smear may show a change and some low level abnormal cells. Low grade changes (known as CIN1) can resolve on their own sometimes, so treatment isn’t usually needed. For 1 in 100, moderate changes (CIN2) may be found. This is called dyskaryosis. For 1 in 200, high grade/severe dyskaryosis (CIN 3) is detected.
[ Treatment ]
If CIN2 or CIN3 is discovered, you will be invited to an appointment, likely at a local hospital, for a colposcopy. This appointment is a bit like re-doing the smear and getting confirmation of the diagnosis; if treatment is needed, you’ll likely be offered to have it done there and then. This isn’t a bad idea as you can get it done out of the way and forget about it until your next screening, but there are cautions to consider, which the nurses will discuss with you before you decide. During colposcopy, a biopsy is usually taken and sent away to the lab to get a more definitive diagnosis if needs be. It can go through your head as to whether the cells, especially if you’ve been told you have severe changes, show cancer, and it’s a worry that you can’t really get rid of. That said, it’s incredibly rare for a smear/colposcopy to show cervical cancer.
The most common treatment seems to be the LLETZ procedure (Large loop excision of the transformation zone). You can read more about this and what to expect, along with the other types of treatments, here. After the treatment, more samples are sent away just to re-confirm that the cells were as anticipated. This can take a couple of weeks, and as someone who’s still waiting for her results I can attest to it being something that challenges your patience when you simply want some peace of mind.
Treatment can reduce the risk of cervical cancer developing by 95%, which is quite reassuring. If you’ve had abnormal results and/or treatment, you will likely be more carefully monitored and have more regular smears too, just to ensure everything is going okay.
[ Say Yes To Screening & Treatment? ]
What I will say in favour of the process of getting a smear and treatment is that things are far more efficient these days and whilst it will of course vary, I was fortunate in finding nurses and specialists to be very reassuring, gentle and pleasant. They stress that the choices are up to you and that you are in control. If you want the test to be stopped, just say so. If it hurts, speak up and let them know. If you have a question, you are given the time and space in which to ask it. They know that smears and cancers and tests are words that instil worry and panic, which is often what makes women apprehensive to go for screening. Once you realise that the process is made as painless as possible, as comfortable as possible, and that even though you think it may be embarrassing they really have seen it all, it becomes more bearable.
I personally think it is a good opportunity because it’s not often a test is offered that can detect cell changes and give you a slight upper hand in dealing with them, giving you a chance to take some control back over your health. I also understand, however, why some may not wish to have screening or treatment. The risks, all be them fairly minimal, with treatment are still risks nonetheless. The likelihood of pre-cancerous cells turning cancerous is debatable and there is a belief that perhaps screening can cause stress and worry unnecessarily. From my perspective, I’m glad I had the smear done and grateful to have had the treatment, despite not having the best of experiences with either.