Cervical screening test

A cervical screening test (smear test) is a method of detecting abnormal cells in the cervix (lower part of the womb).

Cervical screening is not a test for cancer, but it is a test to check the health of the cervix. Most women's test results show that everything is normal. But for one in 20 women, the test will show some changes in the cells of the cervix.

Most of these changes will not lead to cervical cancer and the cells will go back to normal on their own. In some cases, the abnormal cells need to be treated to prevent them becoming a problem later.

The screening programme

In Ireland, cervical cancer is the second most common cancer in women under 35 (after breast cancer). About 280 women a year are diagnosed with cervical cancer.

CervicalCheck - The National Cervical Screening Programme aims to reduce the number of women who develop cervical cancer and the number of women who die from the disease.

All women aged between 25 and 60 are invited for cervical screening. Being screened regularly means that any abnormal changes in the cervix can be identified early on and, if necessary, treated to stop cancer developing.

It is estimated that early detection and treatment can prevent up to 75% of cervical cancers from developing.

Uterus 
The uterus (or womb) is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.

Changes in the cells of the cervix can be caused by certain types of human papilloma virus (HPV).

HPV is the name of a family of common viruses that affect the skin and the mucus membranes (moist tissue that lines parts of the body), such as those in your cervix, anus, mouth and throat.

It is estimated that eight out of 10 people are infected with HPV at some point in their lifetime. For most people, the virus goes away without treatment and does not cause any harm. But infection with some types of HPV can cause abnormal tissue growth and other changes to cells, which can lead to cervical cancer. Other forms of HPV can cause genital warts.

HPV infection is passed on through skin-to-skin contact. The types of HPV that can cause abnormalities in the cells of your cervix are transmitted through sexual contact.

There are high-risk and low-risk types of HPV. Types HPV-16 and HPV-18 are considered high risk for cervical cancer. If you have repeated infections with these high-risk types of HPV, you are more at risk of developing cancerous cells in your cervix.

Regular cervical screening detects abnormal cell changes in the cervix early on, before cancer has had a chance to develop.

If any changes are found, your GP will discuss with you whether to wait and see if the changes go away on their own, or whether you need treatment.

How common are abnormal results?

Nine out of 10 screening results are normal. Around one in 20 show mild cell changes. For most women with abnormal results, the cells will go back to normal without treatment. If your results show abnormal cells, you will be sent for screening every six months to monitor the cells. You will only be given treatment if the cells do not go back to normal.

It is extremely rare for cancer to be diagnosed from a cervical screening test. Less than one in 1,000 test results show invasive cancer.

Disadvantages

As with all screening tests, cervical screening is not 100% accurate. Regular screening can stop up to 75% of cancers from developing, but it does not prevent every case.

It is not yet known which early changes in cervical cells will later develop into cancer and which will not. So some women will be treated for abnormalities that may have cleared up on their own if they had not been treated.

The most important thing is to attend for a smear test when you are invited. A smear test is a simple procedure that only takes minutes and is the most effective way to detect changes in the cells of the cervix.

'CervicalCheck-The National Cervical Screening Programme' offers free tests to all women between the ages of 25 and 60.

The overall aim of the programme is to reduce the incidence and the death rate from cervical cancer in Ireland by providing free cervical screening.

  • Women aged 25 to 44 will be offered a free smear test every three years
  • Women aged 45 to 60 will be offered a free smear test every five years
  • A woman may also be advised by CervicalCheck to attend for additional smear tests if further investigation is needed, as recommended by the designated cytology laboratory through the programme
  • The introduction of screening intervals will avoid opportunistic smears (ad hoc or too frequent regular smears) in the longer term

The programme will be based on:

  • Women attending their registered smeartaker following receipt of a CervicalCheck invitation or re-call letter
  • Women attending their registered smeartaker for a repeat smear test as advised by a letter from CervicalCheck
  • Women attending their registered smeartaker without a CervicalCheck invitation or re-call letter but who are eligible for screening in accordance with the Programme's Eligibility Framework

 

The HPV vaccination

Since 2010, there has been a national programme to vaccinate girls aged 12 to 13 against human papilloma virus (HPV). There is also a three-year catch-up campaign, which will offer the HPV vaccine to girls between the ages of 13 and 18.

The vaccine used in the programme protects against the two types of HPV that are responsible for about 70% of cervical cancer cases (HPV-16 and HPV-18). However, the vaccine does not protect against all types of HPV, so is not guaranteed to prevent cervical cancer.

Following the introduction of the national HPV vaccination programme, regular cervical screening will continue to play an important role in detecting potentially cancerous cell changes in the cervix in women between the ages of 25 and 60.

Who may not need a screening test?

Cervical cancer is rare in the following people:

Women who are not sexually active

The risk of cervical cancer is very low in women who have never been sexually active. As the risk is so low, women in this category may choose not to have a cervical screening test when invited.

However, if you are not currently in a sexual relationship but have been in the past, it is recommended that you have regular cervical screening.

I am under 25 why am I not screened?

International best practice recommends that a population based cervical screening programme should target women aged from 25. Based on evidence to date, there is no additional public health benefit in starting screening below the age of 25.

In women under the age of 25, minor changes in the cells of the cervix are common but invasive cancer is extremely rare. Population based screening in women under the age of 25 may lead to many women receiving unnecessary treatment for not normal cells that would never have developed into cancer

I am over 60; can I have a smear test?

Yes, women over 60 can avail of a CervicalCheck free smear test. You do not need to register to have your smear test, simply make an appointment with a CervicalCheck registered smeartaker. Once you have had this smear test you are automatically part of the Programme.

Women who have had a hysterectomy

Women who have had a total hysterectomy (removal of the womb and cervix) will no longer be invited to attend cervical screening.

Women who have had a hysterectomy which has left all or part of the cervix in place will be invited to screening once their post-operative care has finished.

Women who have had a total hysterectomy for the treatment of cancer, or who had CIN (a type of cervical cell change that can lead to cancer) at the time of total hysterectomy, may need another test called a vault smear. A sample of cells is taken from the vagina, close to where the cervix used to be. Vault sampling is part of the follow-up treatment for hysterectomy but not part of the cervical screening programme.

Making an appointment

To be part of the programme, you can arrange a smear test appointment with any registered smeartaker of your choice. Thousands of GPs, practice nurses, Women's Health, Family Planning and Well Woman Clinics all over Ireland are registered and you can see a full list in the 'Find a Smeartaker' section of www.cervicalcheck.ie

CervicalCheck also sends invitation letters to women who are on the CervicalCheck register. You can check that you are on the register in the 'Check Your Registration/Eligibility' section of this site. If you are not on the register you can add or update your personal details. If you have any questions you can call CervicalCheck on Freephone 1800 45 45 55.

Women who have already had a CervicalCheck smear test since the start of the programme in September 2008 will automatically be re-called by letter when their next smear test is due.

Women must sign the Cervical Cytology Form to take part in the programme and avail of a free CervicalCheck smear test. This allows CervicalCheck to receive, hold and use a woman's personal details and information about her smear test sample.

This may include post-smear samples and colposcopy results. The Cervical Cytology Form has an information sheet attached to it explaining the smear test process and why consent is needed. The information sheet is available to women in Polish, Arabic, Chinese (Mandarin), French, German, Irish, Latvian, Lithuanian, Romanian, Russian and Spanish.

What is the CervicalCheck register?

CervicalCheck has developed a Cervical Screening Register (CSR). This is a list of eligible women aged 25 to 60 from information received from the Department of Social and Family Affairs, from self-registration and colposcopy details.

The CervicalCheck register (list) is a secure electronic database that contains your name, address, date of birth and Personal Public Service Number (PPS No.). The register (list) also records your smear test results and any related procedures that you might have had.

Be assured that your information is secure. To maintain confidentiality, you will be given a unique identification number by the CervicalCheck register. To keep the register (list) up to date, please let us know if there is any change to your personal details such as name or address.

The Health (Provision of Information) Act 1997 allows CervicalCheck to get your name, address and date of birth so that we can invite you for regular free smear tests.

You can have the test at your GP surgery or a family planning clinic. Most women choose to have their test taken by their GP or practice nurse. You can ask to have your test taken by a female doctor or nurse if you prefer.

It is best to have the screening test in the middle of the menstrual cycle (between periods), so book your appointment to coincide with this.

The screening

The smear test usually takes around five minutes. You will be asked to undress from the waist down and lie on a couch. The doctor or nurse will gently put an instrument, called a speculum, into your vagina. This holds the walls of the vagina open so that the cervix can be seen. A small brush-like instrument is then used to gently wipe some cells off the surface of the cervix.

It may be a bit uncomfortable or embarrassing, but for most women it is not painful. If you find the test painful, tell the doctor or nurse because they may be able to reduce your discomfort. Try to relax as much as possible as being tense makes the test harder to carry out. Taking slow, deep breaths will help.

In the laboratory

The process of taking cell samples has been improved in recent years to make it more accurate. The cell sample is now taken using liquid-based cytology (LBC), rather than the Pap (Papanicolaou) smear test that was used previously.

The head of the brush on which your cells have been collected is broken off into a small pot of preservative liquid, or rinsed directly into the preservative liquid.

The sample is then sent to a laboratory, where it is treated to remove any other material that may have been picked up, such as mucus or blood. A sample of the remaining cells is put on a slide and laboratory staff look at the cells under a microscope to see if there are any abnormal cells.

Research has shown that this new method of collecting and testing a sample of cells is more accurate than the Pap smear test and decreases the number of inadequate screening results. This means that you are less likely to be called back for a repeat screening because your test was unclear.

The result of your test will be available from your smeartaker. CervicalCheck will send you a letter about your results within four weeks of your smear test. Most smear test results are found to be normal.

Please try not to worry if you are called back for another test. For women who receive a not normal result, the doctor or practice nurse will explain the result and advise you of recommended follow-up.

If your result is not normal you may need to have another free smear test or a more detailed examination of the cervix using a type of microscope. This test is called a colposcopy.

A colposcopy is free of charge as part of the CervicalCheck programme. If you decide to be referred as a private patient using your private health insurance you will have to pay a fee. If there are cell changes on your cervix they can be easily treated to prevent them developing into cancer cells.

Different types of results:

Normal

This means that there are no cell changes. No action is needed and you do not need your next cervical screening until it is routinely due.

Inadequate

You may be told you need to have a repeat test because the first one could not be read properly. This may be because not enough cells were collected or they could not be seen clearly enough on the slide. You will be asked to go back and have another screening test to take another sample of cells.

Borderline

You may be told your result is borderline. This means that, although there are some cell changes, they are very close to being normal and will go away on their own.

You will be asked to return for another screening test in six months to check that the cells have returned to normal.

Abnormal results

If you have abnormal results, you may be told you have:

  • mild or slight changes (mild dyskaryosis),
  • moderate cell changes (moderate dyskaryosis), or
  • severe cell changes (severe dyskaryosis).

Dyskaryosis is a term used to describe the changes to the cells.

Your results may also refer to CIN. This stands for cervical intra-epithelial neoplasia and is the medical name for cervical changes.

  • CIN 1 refers to mild changes,
  • CIN 2 refers to moderate changes, and
  • CIN 3 refers to severe changes.

All these results show that you have pre-cancerous cells. This does not mean that you have or will get cancer. It just means that some of your cells are abnormal and, if they are not treated, they may develop into cervical cancer.

Not all abnormal changes need to be referred for further investigation or treatment. Your GP may recommend waiting to see if the changes disappear on their own and ask you to return for another screening in six months' time.

If further investigation is needed, your GP will refer you for another screening test or to a specialist (gynaecologist) for an examination called a colposcopy.

A colposcopy

A colposcopy is a simple examination that shows the extent of cell abnormality and helps your GP to decide if you need treatment.

An instrument called a colposcope, which is like a large microscope, is used to look at the cervix in more detail. A small sample of tissue (biopsy) may also be taken from your cervix.

Treatment

If screening shows that you have abnormal cells in your cervix, your GP may recommend that you have them treated. The aim of treatment is to remove or destroy the abnormal cells in your cervix.

It may be possible for you to have treatment at the same time as your colposcopy. Other more invasive types of treatment will require a separate appointment.

Types of treatment:

The treatment you will be offered depends on how many abnormal cells you have in your cervix and how advanced the changes are.

Large loop excision of the transformation zone (LLETZ)

Also known as LEEP or diathermy, this procedure uses a small tool and an electrical current to cut away the affected area of tissue and seal the wound at the same time. The advantage of this treatment is that the cells are removed rather than destroyed, so the tissue can be sent for further tests to confirm the extent of the cell changes and make sure the area of your cervix that contains the cells has been removed.

Cone biopsy

This is a small operation that, in most cases, requires an overnight stay in hospital. A cone of tissue is cut away from your cervix to remove all the abnormal cells.

Cryotherapy

A cold probe is used to freeze away the abnormal cells in the cervix.

Laser treatments

This is sometimes called laser ablation. Lasers pinpoint and destroy abnormal cells in the cervix. If necessary, a laser can also be used to remove a small piece of the cervix itself.

Cold coagulation

A hot probe is applied to the cervix to burn away and remove the abnormal cells.

A local anaesthetic (where the area is numbed but you are still awake) is given before any of the treatments described above. A cone biopsy may require a general anaesthetic (where you are asleep).

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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