Cervical Screening Tests

Overview

A cervical screening test (often called a smear test) checks the health of the cervix, the lower part of the womb that opens into the vagina. It looks for high-risk types of HPV (human papillomavirus) and any abnormal cell changes caused by HPV that could turn into cancer if left alone.

Cervical screening is very common. In the UK, for example, over 3 million people are screened each year as part of the NHS Cervical Screening Programme.

Anyone with a cervix, including women and people assigned female at birth, is usually invited for screening between the ages of 25 and 64. It is less common in people who have been fully vaccinated against HPV, but screening is still recommended.

Symptoms

Common symptoms

• Early HPV-related cervical changes usually cause no symptoms at all.
• Some people may notice bleeding between periods, after sex, or after menopause.
• Occasionally there may be a change in vaginal discharge or pelvic pain.

Symptoms in children

• Cervical screening is not performed in children, and there are no symptoms to look for.

Symptoms in older adults

• Bleeding after the menopause is always a reason to see a doctor, even if you are not due for a screening test.

Causes

Main causes

• Cervical cell changes are caused by high-risk types of HPV (human papillomavirus), which is very common and passed through skin-to-skin contact during sex.
• Most HPV infections are cleared by your immune system, but in some people the infection stays for years and causes abnormal cells to grow.

Risk factors

• Having a weakened immune system, such as from HIV or medicines that suppress the immune system
• Smoking, which makes it harder for the body to clear HPV
• Long-term use of the combined oral contraceptive pill (the risk returns to normal a few years after stopping)
• Starting sexual activity at an early age or having many sexual partners (these increase the chance of HPV exposure)

When to see a doctor

See a doctor urgently if:

• If you have any bleeding after menopause, make an urgent appointment with your GP or local health service.

Book a routine appointment if:

• When you receive your screening invitation letter, book an appointment.
• If you missed a previous screening, contact your practice or local health service to arrange a test.
• If you have any symptoms that concern you, do not wait for your next screening appointment – talk to a doctor or nurse first.

Diagnosis

Cervical screening is the first step. A doctor or nurse takes a small sample of cells from the surface of your cervix using a soft brush. The sample is sent to a laboratory to check for high-risk HPV and any abnormal cell changes.

Tests that may be done

• A speculum examination – a smooth, rounded tool is gently inserted to open the vagina so the cervix can be seen.
• A soft brush is used to gently sweep cells off the cervix.
• If HPV or abnormal cells are found, a follow-up test called a colposcopy may be offered. This uses a magnifying lamp to look closely at the cervix and take tiny biopsies (tissue samples) if needed.

What to expect at your appointment

The screening test usually takes less than 5 minutes. You lie on your back with your knees bent and relaxed. The nurse may use a small amount of warm lubricant on the speculum. You might feel a slight pinch or cramp during the brush, but the test should not be painful. You can ask the nurse to stop at any time.

Treatment

If your screening test shows abnormal cells, you will be offered a small procedure to remove them. These procedures are simple, safe, and prevent the abnormal cells from developing into cancer.

Self-care at home

• After treatment, you may have light bleeding or watery discharge for a few weeks. Use sanitary pads, not tampons or menstrual cups, until you are told it is safe.
• Avoid sex, swimming, and using tampons for about 4 weeks, or as advised by your doctor.
• Ask your doctor or pharmacist about simple pain relief if you have cramps or discomfort.

Medical treatments

The most common treatment is LLETZ (large loop excision of the transformation zone), where a thin wire loop is used to remove the abnormal cells. Other options include laser treatment, cryotherapy (freezing), or cold coagulation (heat). A cone biopsy (a surgical removal of a cone-shaped piece of tissue) may be used for more extensive changes. These are all done under local or general anaesthetic.

When is surgery considered?

A cone biopsy is a day-case surgery that removes a larger area of tissue. It is also used to examine the tissue under a microscope to ensure all abnormal cells have been removed.

Living with this condition

After treatment, you will be given a plan for follow-up appointments, usually a repeat screening test after 6 or 12 months. Your normal life can continue straight away.

Lifestyle tips

• If you smoke, ask your doctor about support to quit. Smoking can help HPV persist and make abnormal cells harder to clear.
• Consider the HPV vaccination if you have never had it – ask your GP or local health service whether it is available to you.
• Practise good sexual health, such as regular STI checks and condoms, if you have new partners.

Diet and exercise

There is no special diet or exercise that gets rid of HPV. Eating a balanced diet with plenty of fruit and vegetables, staying physically active, and maintaining a healthy weight will support your immune system.

Mental health and emotional wellbeing

It is completely normal to feel anxious after an abnormal result or before a colposcopy. Try to talk to someone you trust, and remember that abnormal cells are not cancer and most are treated successfully without causing harm.

Prevention

Nearly all cervical cancers can be prevented. Regular screening and HPV vaccination are the two most effective ways.

Vaccines

The HPV vaccine protects against the high-risk HPV types that cause most cervical cancers. It is usually offered to young teenagers, but in many countries older people can also have it if they ask. The vaccine is most effective at protecting against HPV before you are sexually active, but it can still help.

Screening programmes

Screening every 3 to 5 years (depending on where you live) is the best way to find cell changes early. Even after the HPV vaccine, you still need screening because the vaccine does not protect against all HPV types.

Complications

If left untreated

• If persistent high-risk HPV and abnormal cells are not treated, they can slowly develop into cervical cancer over several years.
• Cervical cancer can eventually cause heavy bleeding, pain, and may spread to nearby organs.

Long-term outlook

The outlook is excellent. Cervical screening is designed to catch pre-cancerous cells before they cause harm. Treatment is very effective, and most people are completely cured without any long-term problems. Even for people who develop early cervical cancer, treatment is often successful.

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