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Cervical screening

A smear test checks for changes in the cells of your cervix (the neck of your womb) that may, if not treated, develop into cervical cancer. The diagram shows the transformation zone – this is the area where cervical cancer usually starts.

Image showing the cervix and transformation zone

What is a smear test?

A smear test is also known as cervical screening. You might also have heard the term Pap smear, which is what people call it in the US. A smear test isn't a test for cancer. Its aim is to pick up any abnormal changes in the cells in your cervix that could develop into cancer in the future. You can then get treatment to stop this happening.

It’s important to remember that a smear test is for women who don’t have any symptoms of cervical cancer. If you have any symptoms you’re worried about, like unusual bleeding or discharge or pain, see your GP. Don’t wait for your routine smear test appointment. See our topic on Cervical cancer for more symptoms to look out for.

NHS cervical screening programme

The NHS runs a cervical screening programme in the UK. It’s offered to all women aged between 25 and 64, every three or five years depending on your age bracket. If you’re registered with a GP, you’ll usually be invited to have a smear test once every three years. Once you reach 50, this will become once every five years. You don’t have to have a smear test at your GP surgery. You can also have one at a family planning or sexual health clinic, for example, or at a private clinic.

At the moment, doctors think that the harms of screening women under the age of 25 outweigh the benefits. Cervical screening doesn’t work as well in women aged 20 to 24 compared to women over this age. It’s common to have changes in the cells of your cervix when you’re younger and most of these go away by themselves. Treating these changes unnecessarily could lead to issues later on. For more information, see our FAQ: Why are there cut-off ages for screening?

Besides age, there are some other things to consider when you’re deciding whether or not to have the test. They include the following.

  • If you’re a virgin, your risk of getting cervical cancer is low so you might decide not to have the test.
  • If you’re not having sex now but have been in the past, you should still go for a smear test.
  • If you’ve had a hysterectomy, you won’t need to have a smear test unless your cervix wasn’t removed. Depending on why you had a hysterectomy, you may be invited to go for a different type of test called a vault smear. Ask your GP for more information.

Smear tests and pregnancy

If you're pregnant and have had normal screening tests before, you can probably postpone any routine screening until three months after your baby is born. But it’s important to check with your doctor or midwife.

If you’ve had an abnormal test and then become pregnant, you may be asked to have more tests, such as a colposcopy at around three to six months into your pregnancy. But sometimes you can delay this until after you’ve given birth – ask your nurse or midwife for more information about what’s best for you.

Deciding on having a smear test

It's your choice whether or not to have a smear test if you’re offered one. It’s important to understand the pros and cons so you can make an informed decision. If you’re still unsure, a nurse at your GP practice can talk things through with you.

Pros

  • Around 3,000 women in the UK get cervical cancer every year. Worldwide, it’s the fourth most common cancer in women. A smear test can help to pick up changes in the cells of your cervix that could lead to you getting cervical cancer in the future. Since the national cervical screening programme was introduced, the number of women developing cervical cancer has halved. It’s thought that smear tests save about 2,000 lives every year in the UK.
  • A smear test is the best way to detect the changes that lead to cervical cancer. Not attending smear tests, along with catching the HPV virus, are two things that most increase your risk of getting cervical cancer.

Cons

  • Although a smear test is the best way to check the health of your cervix, it isn't a perfect test. Like all screening tests, it can’t work 100 per cent of the time. It’s possible your nurse or doctor might miss some abnormal cells in your test. This means your results could say your cells are normal, when in fact you have some abnormal cells that could develop into cancer. This is called a false negative test. This is why it’s so important to go for regular screening tests so they can be picked up next time.
  • Your screening test may show up mild cell changes in your cervix, which would never have developed into cancer, or caused you any problems. If this happens, you may receive treatment that you don’t really need. Very occasionally, screening can show you have abnormal cells when in fact there’s no problem. This is called a false positive result. If your test shows abnormal cells, you’ll be offered further tests, or treatment which may cause you unnecessary problems if it turns out you didn’t really need them.

Preparing for a smear test

It’s best to make your appointment for a smear test when you’re not on your period. If you’re bleeding, the sample your nurse gets probably won’t be clear so you’ll probably need to have the test again. The best time to have a smear test is halfway between one period and the next.

In the 24 hours before your smear test, if you use contraception, it’s best not to have sex. This is because chemicals in spermicide, lubricating jelly or condoms can affect the test.

What happens during a smear test?

The appointment for a smear test usually lasts about 10 minutes but the actual test only takes a minute or two. A (female) nurse will usually do your test. If you want to be sure your nurse will be a woman, ask when you make your appointment.

First, your nurse will ask you to undress from the waist down. You’ll then lie on your back on a couch, with your knees bent and apart. If you can’t get into this position easily, tell your nurse – you might be able to lie on your side for the test instead.

You may find the test uncomfortable but it doesn’t usually hurt. If it does hurt, let your nurse know so they can try and make it more comfortable for you. Try to relax – the more relaxed you are, the less discomfort you’ll feel. You might find it helps to take some deep breaths.

Your nurse will use an instrument called a speculum to gently open your vagina, so they can see your cervix (neck of your womb). They’ll then use a small brush to take a sample of cells from your cervix. They’ll send this sample to a lab to be tested.

What to expect afterwards

You can carry on as normal straight away after your smear test. You might bleed a bit afterwards but if you have heavy bleeding or severe pain afterwards, see your GP.

Getting your results

Your nurse will let you know when you can expect to receive your results. They’re usually sent to the surgery or clinic where you had the smear test, as well as to your home address. Your results should be ready within two weeks, but sometimes it can take longer. If you don’t hear anything within six weeks, contact your GP practice or clinic.

Most smear tests – more than nine out of 10 – are normal. If your test is normal, you’ll be invited back for routine screening after three or five years, depending on your age.

Sometimes the result may be 'inadequate' or 'unsatisfactory' because there weren’t enough cells in the sample, or the cells couldn’t be seen clearly. This may be because of an infection, for example. If this happens, you’ll be asked to have another test after three months.

Getting an abnormal result

If you get an abnormal result, it doesn’t mean you have cancer. It means that you have some changes to the cells from your cervix. This is called dyskaryosis. These changes might go away on their own, but for some women, they might develop into cancer if they’re not treated. What happens next depends on how abnormal your cells are.

Borderline or mild changes

Your test result may say that you have cells with ‘borderline’ or ‘mild’ changes. Although these don’t usually develop into cancer and may well return to normal by themselves, they need to be checked. Your sample will be tested for high-risk human papilloma virus (HPV) because some types of HPV can increase your risk of cervical cancer. See our topic on cervical cancer to find out more.

  • If high-risk HPV is found in your sample, you’ll be offered a further test called a colposcopy to look at your cervix more closely.
  • If you don’t have a high-risk HPV in your sample, you have a low risk of developing cervical cancer before your next smear test. So, you won’t need any further tests and can go back to having routine smear tests as usual.

Moderate or severe changes

If your test result says that you have cells with ‘moderate’ or ‘severe’ changes, it’s still unlikely that you have cancer. But cells with these changes are less likely to return to normal on their own so you may need treatment. You’ll probably be offered a colposcopy to examine your cervix and to see if you do need treatment. You can read about your options in our FAQ: How are abnormal cervical cells treated?

FAQ: Can a smear test pick up if I have an infection?

The aim of a smear test is to detect any changes to the cells in your cervix, rather than to check for an infection. But if you have an infection, this may be picked up during the test and reported by the lab that tests your sample.

Not all vaginal infections show up in a smear test. Infections that do include Candida (thrush), herpes simplex 2 (a viral infection) and Trichomonas (a tiny parasite). If your smear test suggests you may have an infection, your GP may offer you treatment.

You’ll be offered another smear test once your infection has gone.

FAQ: Do I need a smear test if I'm not having sex?

Yes. It’s important to have your routine smear tests even if you aren’t having sex at the moment.

Smear tests check for changes in the cells of your cervix that may, if untreated, develop into cervical cancer. These changes usually develop if you get a human papilloma virus (HPV) infection, which is linked to the development of cell changes and to cervical cancer.

HPV infections are really common and can be passed on through having sex. Most women get HPV at some point in their lives. Most of the time your body will fight off the infection and you won't know that you’ve had the virus. A smear test will check for the cell changes that are caused by HPV infection.

If you’ve had sex in the past, even if you're not sexually active now, you should still have regular smear tests. This is because you may have been infected with HPV from a previous partner, even if it was months or years ago. In some women, the virus can lie dormant for this time and cause abnormal cells later on.

If you’ve never had sex and are a virgin, you’re very unlikely to develop cervical cancer. But there may still be some small risk, so you may decide that you do want to have regular smear tests.

If you have sex with women, it’s still important that you have regular smear tests. This is because HPV can be passed on through sexual contact between women as well as with men.

FAQ: How are abnormal cervical cells treated?

There are different treatments, which either destroy the abnormal cells or remove the area of your cervix where the cells are.

If your smear test shows cells with moderate or severe changes, you’ll be asked to have a colposcopy. If the doctor or nurse doing your colposcopy finds an area of your cervix that looks abnormal, they’ll take a biopsy. This is a small sample of the abnormal tissue, and they’ll send this to a lab to be tested.

Depending on the result, you may need to have treatment to remove or destroy your abnormal cells. The usual way to do this is called a large-loop excision of the transformation zone (LLETZ), also known as loop diathermy. In this procedure, your doctor will use a wire loop with an electric current to remove abnormal cells.

You’ll usually have this treatment under local anaesthesia so you’ll be awake. General anaesthesia may also be an option.

Other treatments that can destroy abnormal cells include laser therapy, cryotherapy (freezing) and cold coagulation. Ask your nurse or doctor for more information about these.

FAQ: Why are there cut-off ages for screening?

The NHS currently invites women between the ages of 25 and 64 for smear tests. The invite goes out every three years for 25 to 49-year olds, and every five years for 50 to 64-year olds. These age limits and time intervals are based on research. The NHS continues to keep an eye on the latest evidence to check that these decisions remain appropriate.

Research into the best age to screen for cervical cancer suggests that the harms of screening women under the age of 25 outweigh the benefits. When you’re under 25, it’s common to have changes in the cells of your cervix and these generally go away by themselves. The number of women who go on to develop cervical cancer at this age is very low.

If these changes are picked up in screening, it could lead to you having unnecessary treatment. And there are some important risks associated with the treatments that you should consider. These include the following.

  • If you’re found to have abnormal cells, it’s natural to be anxious about this and to worry. Yet the chances are that the changes would have gone away by themselves at this age.
  • You could bleed more heavily during your periods after having a loop excision.
  • If you have a baby later on in life, there may be a greater chance of giving birth early. The evidence for this is mixed and it’s only with some treatments, but it’s still an important factor to consider. The loop excision treatment may also increase your risk of having a miscarriage.

Screening hasn’t been shown to reduce the incidence of cervical cancer in women under the age of 25. So since screening may lead to unnecessary treatment, it simply isn’t thought to be worth the risk.

The reason for the upper age limit for screening is that smear tests aren’t as good at detecting abnormal cell changes later in life. And after you reach the age of 65, you’re far less likely to have abnormal cells and go on to develop cervical cancer. Most women who do get cervical cancer over the age of 50, turn out not to have attended all their smear tests in the past. So, if this is the case for you, you might still be offered a smear test if you haven’t taken part in the cervical screening programme before.

If you’re outside the age limits for screening, and have symptoms like unusual bleeding or discharge, or pain, contact your GP or local sexual health clinic. See our topic on Cervical cancer to learn more about the symptoms.

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    Further information

    Sources

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    • Cervical screening programme England, 2015–16. National Statistics. www.content.digital.nhs.uk, published 15 November 2016
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    • Loop electrosurgical excision procedure (LEEP). Medscape. emedicine.medscape.com, updated 3 August 2016
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    Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, August 2017
    Expert reviewed by Mr Robin Crawford, Consultant Gynaecologist
    Next review due August 2020

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