A cervical screening test (smear test) is a method of detecting changes in the cells of the cervix (neck of the womb). Cervical screening is not a test for cancer, 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 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 will need to be treated to prevent them becoming a problem later.
The screening programme
The overall aim of CervicalCheck, the National Cervical Screening Programme, is to reduce the incidence of and mortality from cervical cancer in Ireland by providing free cervical screening to women habitually resident in the Republic of Ireland aged between 25 and 60 years of age.
Women aged between 25 and 60 are invited for cervical screening. Being screened regularly means that any changes in the cells of the cervix can be identified early on and, if necessary, treated before cancer develops.
With an organised cervical screening programme, it is estimated that early detection and treatment can prevent up to 75% of cervical cancers from developing .
'CervicalCheck offers free tests to women between the ages of 25 and 60.
- Women aged 25 to 44 are offered free cervical screening tests every three years
- Women aged 45 to 60 are offered free cervical screening tests every five years
- Following their screening tests, women may be referred by their doctor to attend for further investigation at a CervicalCheck colposcopy clinic
- 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).
In Ireland, cervical cancer is the most frequent HPV-associated cancer with on average 292 cases per year (NCRI, HPV-associated Cancer Trends Report, May 2017).
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 HPV types can cause changes to cells in the cervix, which can lead to cervical cancer. Other HPV types 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 can detect early cell changes in the cervix before cancer has developed.
If any cell changes are found, your doctor or nurse will discuss the next steps in your cervical screening pathway with you.
How common are abnormal results?
Nine out of 10 cervical screening results are normal and approximately one in 20 show mild cell changes. For most women with changes in the cells of the cervix, the cells will go back to normal without treatment.
If the laboratory detects low-grade changes in the cells, you will they will do a test for the presence of certain types of HPV. If HPV test is positive, your doctor will refer you to a CervicalCheck colposcopy clinic for further investigation. If the HPV test is negative, CervicalCheck will let you know when your next screening test is due
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.
Cervical screening will not prevent all cases of cervical cancer. Cervical screening tests, like other screening tests, are not 100% accurate. A result may be negative even though there are changes to the cells of the cervix (this is called a false negative). This is why it is important to have regular tests and to consult your doctor if you have any symptoms. A result may be positive even when there are no changes to the cells of the cervix (this is called a false positive). If your result is positive, you will be offered a more detailed investigation called a colposcopy. Some women may be treated for abnormalities that may have cleared up on their own.
The HPV vaccination
Since 2010, there has been a national, school based programme to vaccinate girls aged 12 to 13 against human papilloma virus (HPV). There is also a three-year catch-up campaign, which offers the HPV vaccine to older, unvaccinated girls who are still at school and who might have missed out on previous vaccination rounds.
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. This is the reason why it is important for vaccinated women to continue to attend for cervical screening.
Who may not need a cervical screening (smear) test?
Cervical cancer is rare in the following people:
Women who have never been 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 from 25 years of age. 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 screening test?
Yes, women over 60 can avail of a free Cervical screening test, if you have never had a test with the programme.You do not need to register to have your cervical screening test, simply make an appointment with a doctor or nurse registered with CervicalCheck. Once you have had this screening 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) no longer require cervical screening. If you have had a total hysterectomy, you should contact CervicalCheck.
Any woman who is unsure if they should attend for screening following a hysterectomy should consult with their doctor.
For further information, visit CervicalCheck’s website