More than 1 million women failed to take up their cervical screening invitations last year, marking a 19 year low in smear test attendance. It’s all too easy to allow booking your smear test appointment to slip off your to do list, but it really could save your life – the NHS estimates that its cervical screening programme prevents 4,500 cases of cervical cancer each year. If you’ve been ignoring those letters from your GP surgery, it’s time to pick up the phone. Find out exactly what to expect with our handy guide.
What is a smear test?
A smear test tests for the presence of cell changes on the surface of the cervix (or neck of the womb) which might develop into cancer over a number of years if left untreated. It is not a cancer test. 7 out of 10 cases of cervical cancer can be prevented by cervical screening.
The term ‘smear’ comes from the old process used to look at cell samples after the test – cells brushed from the cervix were ‘smeared’ onto a glass slide ready to be looked at under a microscope. This method has been replaced by liquid based cytology (LBC). Cells are now immersed in a vial of liquid to help preserve them before they can be looked at more closely in a laboratory.
A smear test is often called a pap smear or pap test in America. This name comes from the inventor of the smear test, George Papanicolaou, also known as ‘Dr Pap’.
How often should you have a smear test?
If you are of smear test age, you will be invited to make an appointment for a cervical smear test every 3-5 years. If you are aged 25-49, you should have a smear test every 3 years. If you are aged 50-64, you should be tested every 5 years. If you have received abnormal smear results in the past, you may be asked to attend more often. If you are 65 or over and have had three normal test results in a row, you will not be invited back, since it is highly unlikely that you will go on to develop cervical cancer. If you are over 65 and have never had a smear test, you are entitled to one and should book an appointment.
If you are registered with a GP, you should receive a letter when your smear test is due. If you are not registered with a GP, do not receive an invitation or experience symptoms such as unusual bleeding or pain during sex between tests, contact your GP or local sexual health clinic to book an appointment.
If you have not yet been through the menopause, you should try to book your smear test so that it falls midway through your menstrual cycle. Try not to have sex for 24 hours before a smear test, as the presence of sperm can make it difficult to obtain and interpret cell samples.
How long does it take?
A smear test appointment generally takes no longer than 20 minutes, with the test itself lasting around 3 minutes.
Who does it?
Smear tests are usually performed by a practice nurse, but you may request a GP or female nurse if this makes you feel more comfortable.
What to expect before your smear test
The doctor or nurse will probably ask you a few questions about your general and reproductive health. For instance, they may ask when you last had a period, when you last had a smear test, whether you are experiencing any unusual symptoms and how much you smoke, drink and exercise. You may also be weighed and have your blood pressure checked.
You will then be asked to undress from the waist down (behind a screen). If you are wearing a skirt, you can leave this on and just remove your knickers. You’ll then be asked to lie on an examination bed, usually on your back with your feet flat on the bed and knees bent up. Alternatively, you may be asked to place your legs in stirrups, or to lie with your feet together and knees apart. Your lower body will be covered by a paper sheet.
What to expect during your smear test
The doctor or nurse will gently insert a plastic speculum into your vagina. This shouldn’t hurt, but may feel slightly uncomfortable. The speculum will then be gently opened to allow the person taking your test to see your cervix. They will then use a special brush to take a sample of cells from the surface of your cervix. This may feel slightly strange, but shouldn’t hurt and takes just a few seconds. The cell sample will then be immersed in a vial of special liquid to help preserve it before it can be sent to a lab to be looked at under a microscope.
What to expect after your smear test
Once your sample has been collected, the doctor or nurse will gently close and remove the speculum, before leaving you alone to get dressed.
Bleeding after a smear test
It is normal to experience light bleeding or spotting for a few hours after a smear test. You might like to bring a sanitary towel or panty liner with you just in case (some GPs also have these on hand). If the bleeding is very heavy or lasts longer than 24 hours, tell your GP.
Smear test results
You should receive a letter informing you of your smear test result within 2-6 weeks. Alternatively, your GP may ask you to call in for your result. Smear test results are 80-90% reliable, although a few false positives (receiving an ‘abnormal’ result when no abnormalities are present) and negatives (normal results when an abnormality is present) do occur.
90-94% of smear test results are normal. If yours isn’t, don’t panic.
An ‘inadequate’ result usually means that too few cells were taken to perform an accurate assessment, or that blood, sperm or mucus obscured the sample. You will usually be asked to take a repeat smear test.
‘Abnormal’ results are graded according to the degree of cell changes detected. In the vast majority of cases, these cell changes are not cancerous. However, if left untreated, they may develop into cancer at a later point in time.
Low grade changes may be referred to as mild, borderline or low grade dyskariosis, or CIN1 (CIN stands for cervical intra-epithelial neoplasia). In most cases, low grade changes return to normal on their own, without treatment. However, if you show signs of low grade changes and your sample tests positive for high risk HPV, you will be invited to attend a colposcopy appointment. HPV is a sexually transmitted infection which causes more than 99% of cases of cervical cancer. It is transmitted by skin to skin genital contact, and almost every woman will be infected at some point in her lifetime.
High grade changes may be referred to as moderate or severe dyskariosis, CIN2 or CIN3. If your results indicate high grade changes, you will be referred for colposcopy. High grade changes usually require treatment.
Glandular dyskariosis indicates the presence of possible cancer cells. If your result indicates the presence of abnormal glandular cells, you will be referred for colposcopy for further investigation.
What is colposcopy?
A colposcopy appointment is similar to a smear test, but usually takes place at a specialist clinic. The colposcopist, a specially trained doctor or nurse, will insert a speculum into your vagina, then use a special microscope to take a more detailed look at your cervix. Don’t worry – the microscope stays outside your body! The colposcopist will brush a number of solutions onto your cervix to look for evidence of cell changes. They may also take a small sample of cells (no bigger than a match head). Colposcopy usually takes about 15 minutes.
If you require treatment, you will be asked to return at a later date. Treatment typically involves freezing, burning, lasering or cutting out the abnormal cells. Don’t panic – it doesn’t hurt. In most cases, treatment is carried out under local anaesthetic – in fact, the experience is similar to colposcopy. In a few cases, treatment may be carried out under general anaesthetic. You may experience bleeding and unusual discharge for a few weeks following treatment, and should avoid tampons, sex and swimming until these symptoms stop.
Treatment to remove abnormal cells is almost 100% effective in preventing cervical cancer. However, you should continue to attend for regular smear tests.