A Guide To Smear Tests & Abnormalities

Photographed by Tayler Smith.
It’s not the most exciting or sought-after invitation. But if you’re in your mid-20s and live in the U.K., you’ll have probably received a letter inviting you to come for a cervical screening – also known as a ‘smear’. It’s all too easy to shuffle that letter in your pile of neglected post, or add booking an appointment to the bottom of that ever-lengthening to-do list. Because smears are a private and intimate examination, some women are put off by the idea, says Dr Lisa Carter, a GP based in London. The connotations of the word 'smear' don’t help, either. But the procedure is nothing to be feared, says Carter. “It’s really, really important that people go for them and most smears are absolutely fine.”

Why do I need one?

It’s a common misconception that smear tests are carried out to check for cervical cancer; they are actually designed to pick up any precancerous changes – which means any variations or abnormalities in the cells that have the potential to become cancerous. Getting regular check-ups means abnormalities are “much more treatable than if they were left for a long time,” explains Carter. Cervical cancer mainly affects sexually active women aged between 30-45. In the U.K., about 3,000 women are diagnosed with it every year. In England, women are called to get their first smear aged 25. Women in Wales are asked at 20, although it’s extremely rare for a woman to be diagnosed with cervical cancer between the ages of 20-25, says Carter. It is recommended that women get tested every three years, until they are 49. After that, in England, they get tested every five years, until they are 64. Because cell changes can occur many years before cancer develops, the cervical screening programme has been very successful, overall. Since it was introduced in the 1980s, the number of cervical cancer cases has decreased by about 7% each year.

How does it work?

When you receive a letter, call your surgery to arrange an appointment with a GP or practice nurse. It is also possible to book an appointment at your local well woman or sexual health clinic. It is best to do this in the middle of your cycle, which is about 14 days after the first day of your last period. During a smear test, the clinician needs to examine the surface of your cervix, which is the neck of the womb, and take a swab of cells from the area. The procedure is similar to the one used to test for sexually transmitted infections. You will be asked to undress from the waist down and lie on a couch, with your legs bent and open. The clinician then inserts a plastic tong-like instrument called a speculum into your vagina. The speculum is usually about 8cm long – but it comes in different sizes, depending on the woman. When the speculum is inside, the clinician squeezes the handles, opening the walls of the back of the vagina, to about 5-8cm wide. They are then able to see the cervix in all its glory and look for any irregularities on the surface, sometimes using a light to help. Then a soft brush is inserted and gently twirled around to collect a swab of cells from the area. The procedure is over in about five minutes.

Will it hurt?

The procedure can be a little uncomfortable, says Carter, but it shouldn’t be painful. Sometimes it can be difficult to visualise the cervix, so might take a bit longer. If you are in any pain or discomfort, tell the clinician. And try to relax, as tension makes the procedure harder to carry out. Occasionally, women might experience a bit of spotting afterwards. “Women should be advised that that’s normal and not to panic if that happens,” she says.

What happens next?

The clinician will send your cells off to the lab for testing and you should get your results after two weeks. Most test results show that everything is normal. Only in one in 20 cases will there be abnormalities. If you have an abnormal smear it’s important not to panic. According to the NHS, most abnormal cells will not be cancerous, and will often change back on their own. In some cases, they will need to be removed. Statistically, there is a very small risk that a woman with an abnormal smear will develop cervical cancer – about one in 2,000. If minor changes to cells are found, or the sample taken was not sufficient, then you will be invited back for a second smear. If more significant changes are detected, you’ll be referred to a specialist clinic for a procedure called a colposcopy. This procedure is similar to a smear: a microscope is inserted into your vagina to allow for a closer examination of the cervix. The colposcopist may take a tissue sample and will be able to determine whether further treatment is needed.

What about HPV?

Changes to the cells are often caused by the human papilloma virus (HPV), a sexually transmitted infection. There are more than 100 different types of HPV – some of which are considered low-risk and some high-risk, leading to cervical cancer. If a sample taken during a smear has even a low level of abnormal cells it will also be tested for HPV. If HPV is detected, you will be referred for a colposcopy. The HPV virus is common, and about four out of five adult men and women have had it at some point in their lives. But only a small minority with the infection have an abnormal smear and a smaller fraction still get cervical cancer. So you there you have it. Despite its off-putting name, the smear test really is no big deal. While the chances of having abnormalities are slim, the reason screening has been so successful over the years is because problems are caught early. Stay on the right side of the statistics and bump the smear up to the top of your to-do list.

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