Cervical Screening Awareness Week: 12 things people wish they knew about smear tests

The C word, or the double C word in this case, is scary. But why when 99.8% of cervical cancer cases in the UK are preventable, according to Cancer Research UK, are we so reluctant to have our routine cervical screenings?

As many as one in three of us don't attend our first appointments, found by Jo's Cervical Cancer Trust to be partly due to embarrassment (26.7%) and not thinking it reduces the risk of cervical cancer (70%).

But this is likely to be caused by the lack of education and reassurance for women and people with a cervix (which is the opening to the womb from the vagina).

Many will also remember the first time they received an invitation for a cervical screening (usually just before turning 25), or getting a test result they didn't understand.

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Some 220,000 people are told every year they have cervical cell 'changes' after a screening, with many more given a HPV diagnosis, which can mean more tests and treatments for some, causing worry.

So, what are the things people most wish they knew about cervical screenings and results, before even beginning the process? Samantha Dixon, Chief Executive, Jo's Cervical Cancer Trust, explains below.

1) "Screening is not a test for cancer, it's a test to help prevent cancer"

This might be obvious to some, but is still completely unknown to others – if more people knew this key difference, it's likely fewer people would fear going for their smear test.

The screening helps prevent cancer, Dixon explains, "by finding out who is at higher risk" and "by looking for human papillomavirus (HPV), the virus which can cause your cells to change".

During a smear test, a sample of cells is taken from the cervix, which is then checked for certain types of human HPV. This virus itself is not cancer, but if found, it has the potential to cause changes in the cells of the cervix, which can then turn into cervical cancer. However, if discovered in time, preventative treatment can be given, before the cells even have the chance to change.

Dixon also says one in five people mistakenly believe cervical screening can detect ovarian cancer.

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2) "There is no difference between cervical screening and a smear test"

These are just two different names for the same test. "A smear test is the older name for the test. It was called that because of the way the test used to be done – cells were smeared on a glass slide, which was sent to the laboratory for testing," explains Dixon.

"The test is different now and most healthcare professionals call it 'cervical screening'."

3) "Speculums come in different sizes. If you find the standard size too uncomfortable, you can ask to try another size"

A speculum is the instrument used during a screening, which is inserted into the vagina to open its walls up slightly so the cervix can be seen. A soft brush is then inserted, which is what is used to take the sample.

"Everyone is different, and for some people a smaller speculum size might feel better. Just ask your nurse," says Dixon.

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4) "It is best not to book a cervical screening when you have your period"

This is because it can make it harder to get a clear result. "If the result is inadequate, which means it can't be properly examined, you will be invited back in three months' time for another test," she says – so it's best to save yourself the hassle and get an appointment accordingly.

Dixon also adds that you should try not to use spermicide or oil-based lubricant (lube) for 24 hours before the test, as this too can affect the results.

5) "If you have gone through or are going through the menopause, let your doctor or nurse know"

“After menopause, the opening of the vagina and vaginal walls become less able to stretch, which can make the test more uncomfortable. You can ask your nurse to give (prescribe) you a vaginal oestrogen cream or pessary, which may help,” she explains.

6) "Cervical screenings are not for people who have symptoms"

Dixon advises, “If you have symptoms, contact your GP surgery about having an examination.” As she points out, these are not what screenings are designed for, as they are a prevention tool. If you’re worried about symptoms of cervical cancer, such as bleeding between periods, during or after sex, or after the menopause, or vaginal discharge, book an appointment with your GP as soon as possible, rather than waiting for your routine one.

Read more: Chrissy Teigen reminds women not to skip their smear test during coronavirus pandemic

7) "Everyone's experience of cervical screening is different"

While smear tests aren't anything to fear, Dixon points out that, "Some people don't find it uncomfortable, while for others it may be uncomfortable or hurt," so there is no defined normal. "There are lots of reasons, physical and psychological, for this," she continues. "It's important to tell your nurse or doctor if cervical screening is painful for you."

8) "The HPV vaccine does not protect you against all types of HPV"

Even if you remember getting that jab that made your arm hurt at school, or at your sexual health clinic, it doesn’t offer full protection, which is why “cervical screening is still important even if you’ve had the vaccine,” she explains.

9) "All women and people with a cervix between age 25 and 64 can go for regular cervical cancer screenings, no matter their sexual orientation or gender identity"

This includes lesbian and bisexual women. Trans men and non-binary people who have a cervix should also attend regular screenings, but as they might not receive invitations through the national screening programme, they can ask their GP to send them invites directly.

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10) "[False] ’HPV means you are unclean or to blame’: [True] HPV is a common virus”

While we might be hyper-sensitised to viruses at the moment, Dixon points out that as many as eight in 10 of us will have HPV at some point in our lives, so it’s really hard to avoid.

“Having HPV isn’t a sign that someone has slept with a lot of people or been unfaithful to a partner, because you can get it during your first sexual intercourse – whether that is penetrative sex, oral sex, touching or sharing sex toys,” she explains.

11) "There is no treatment for HPV itself"

HPV itself is usually harmless, and most HPV infections do not cause any problems, naturally going away within two years. “Many HPV infections will be cleared by the immune system, and lots of cell changes will also go without the need for any treatment. So an unexpected cervical screening result doesn’t mean you need to panic.”

However, there are treatments for conditions caused by HPV, including genital warts, cervical cell changes and cancer. “If treatment is needed, it is given to prevent cancer too.”

12) “Being told you have HPV or cell changes caused by HPV does not mean you do have, or will develop cancer”

Officially, these are how the results of cervical screenings work, as per the NHS.

HPV not found: Most people will have this result (HPV negative), which means the risk of getting cervical cancer is very low, and you’ll be invited for screening again when you’re next automatically due one.

HPV found: Your results letter will explain what happens next if this is the outcome (HPV positive), but you might need another cervical screening test in one year, or a different test to look at your cervix (a colposcopy).

HPV found but no abnormal cells: With this branch of HPV positive, you’ll be invited for screening in one year and again in two years if you still have HPV. If you still have it after three years, you might need a colposcopy.

HPV found and abnormal cells: With this branch of HPV positive, you’ll be invited to a colposcopy.

In summary, Dixon says, “Cervical screening tests for HPV and if present, cervical cell changes caused by HPV. If you have both you will be invited for a colposcopy to take a closer look at the cells. If you just have HPV then you will be invited back for cervical screening in just one year to see if the immune system has cleared the infection.”

She adds, “It’s slightly different in Northern Ireland as an older testing method is used. In Northern Ireland you are not tested for HPV, and instead will be told if you have any cell changes or not.”

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Hopefully, more information repeatedly given about HPV, cervical screenings, and results, will help to improve the current lack of understanding out there – and now's a friendly reminder to book that smear test.

“We want everyone to have the support and facts they need to access cervical screening and deal with an unexpected result. Cervical screening can help stop cervical cancer before it starts so it’s an incredibly important test. Help raise awareness by sharing your story this week and show others they aren’t alone,” says Dixon.

You can join in with Cervical Screening Awareness Week using the hashtags #CervicalScreeningAwarenessWeek or #CervicalScreeningTips, or for any help or questions, visit Jo's Cervical Cancer Trust at @JoTrust, jostrust.org.uk or call 0808 802 8000.