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Smear test (cervical screening)


Expert reviewer, Dr Robin Crawford, Consultant Gynaecologist
Next review due December 2022

The cervical screening test checks for human papilloma virus (HPV) infection and changes in the cells covering the neck of your womb. These changes could later develop into cervical cancer if they aren’t treated.

Image showing the cervix and transformation zone

What is cervical screening?

Screening means testing for early signs of an illness before you have symptoms. Cervical screening picks up changes in the cells covering the cervix (the neck of your womb) that could develop into cancer in the future. It isn’t a test for cancer. It’s a test for abnormal pre-cancerous changes in these cells, which can then be treated to stop cancer developing. Cervical screening is highly effective at preventing cervical cancer. It saves around 4,500 lives every year in England alone.

Cervical screening used to be called a smear test. You might also have heard the term Pap smear, which is what people call it in the USA.

The cell sample that your nurse takes will be tested for certain high-risk types of the wart virus, human papillomavirus (HPV). This is called HPV primary screening. HPV infection causes more than 99% of cervical cancers. If you don’t have HPV, you are very unlikely to have abnormal cells or to develop cervical cancer. This means the cells in the sample won’t need to be examined further.

If HPV is found, your cell sample will then be checked for any abnormal changes. There is more information about what happens next in the section: Getting your results.

Remember that cervical screening is for women who don’t have symptoms. If you have any symptoms you’re worried about, such as bleeding between periods or after sex, vaginal discharge or pain, see your GP. Don’t wait for your routine screening appointment.

The diagram shows the transformation zone — this is the area where cervical cancer usually starts and from where cells are taken for testing.

NHS cervical screening programme

The NHS runs a cervical screening programme in the UK for all women aged 25 to 64. You have screening every three or five years, depending on your age.

If you’re between 25 and 49 and registered with a GP, you’re usually invited for screening every three years. Once you reach 50, you’re invited every five years.

You don’t have to have the test at your GP surgery. You can also have one at a family planning or sexual health clinic or at a private clinic.

At the moment, doctors don’t think it’s helpful to screen women under 25. 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.

Women of 65 and over are very unlikely to develop cervical cancer if their last three results were normal. There is more about this in our FAQ: Why are there cut-off ages for screening?

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Who needs to have cervical screening?

Women who have had any type of sexual contact with men or women (including touching or using sex toys) should have cervical screening. If you haven’t had any sexual contact, you might decide against screening. But even though the risk is small, you may want to have regular screening. You should still report any unusual bleeding or discharge to your GP.

If you’ve ever had sex, even if you aren’t now, you should still have screening. Screening will pick up human papilloma virus (HPV) infection, which causes the cell changes that lead to cervical cancer. You may have been infected with HPV by a previous partner, months or even years ago. The virus can lie dormant and cause abnormal cells later on.

HPV infections are really common and can be passed on through having sex and sex toys. 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 have the virus.

If you’ve had a hysterectomy, you won’t need screening unless your cervix wasn’t removed. Depending on why you had a hysterectomy, you may be asked to have a different type of test called a vault smear. Ask your GP for more information.

Cervical screening and pregnancy

If you're pregnant and have previously had normal screening tests, you can probably postpone routine screening until three months after having your baby. But do 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. Your doctor may suggest a colposcopy three to six months into your pregnancy. But sometimes you can delay this until after you’ve given birth – ask your nurse or midwife what’s best for you.

Deciding on having a cervical screening test

It's your choice whether or not to have a cervical screening test if you’re offered one. Below are some pros and cons to help you make an informed decision. If you’re still unsure, talk it over with a nurse at your GP practice.

Pros

  • Around 3,200 women in the UK get cervical cancer every year. Worldwide, it’s the fourth most common cancer in women. Screening can pick up changes in the cells of your cervix that could lead to cervical cancer in the future.
  • Since the national cervical screening programme was introduced, the number of women dying from cervical cancer has halved. Cervical screening saves about 4,500 lives every year in England.
  • A screening test is the best way to find out if you have HPV. Having the HPV virus is the single biggest risk for developing cervical cancer.

Cons

  • Although screening is the best way to check the health of your cervix, it isn't perfect. Like all screening tests, it doesn’t work 100% of the time. It’s possible some abnormal cells could be missed. If so, your result 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. This is why it’s so important to go for regular screening tests, so any abnormal cells can be picked up next time.
  • Very occasionally, screening can show you have abnormal cells when in fact there’s no problem. This is called a false positive result. In these situations, you may be asked to have further tests that you don’t really need and that could cause you anxiety.

Preparing for a cervical screening test

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

For two days before your test, you shouldn’t use any spermicide (including condoms coated with spermicide), lubricating jelly or vaginal creams. This is because chemicals in these products can affect the test.

What happens during a cervical screening test?

The appointment usually lasts about 10 minutes but the actual test only takes a minute or two. Usually a female nurse or doctor will do your test, but if you want to make sure, ask when you make your appointment.

After undressing from the waist down, you lie on your back on a couch with your knees bent and apart. If you can’t manage this easily, tell your nurse – you may be able to lie on your side instead.

Some people find the test uncomfortable but it doesn’t usually hurt. If it does hurt, let your nurse know so they can try and make you more comfortable. 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 screening test. You might bleed a bit afterwards but if you have heavy bleeding or pain, see your GP.

Getting your results

Your nurse will let you know when you can expect your results. They’re usually sent to the surgery or clinic where you had the screening 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.

Around seven out of every eight cervical screening tests are normal. You’ll then be invited back for routine screening in another 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 or you may need some treatment before it is repeated.

Getting an abnormal result

If you get an abnormal result, it doesn’t mean you have cancer. It means one of the following three things:

  • you have HPV but your cervical cells look normal
  • you have HPV and also have borderline or mild changes to your cervical cells
  • you have HPV and moderate or severe changes to your cervical cells

Changes to the cells from your cervix is called dyskaryosis. These changes might go away on their own, but they might develop into cancer if they’re not treated. What happens next depends on how abnormal your cells are.

Having HPV but no abnormal cells

If your screening test shows you have HPV but normal cervical cells, you’ll be asked to have another test a year later. This is to see if the infection has gone. In most people, HPV clears up with the help of their immune system. If the infection hasn’t gone, your risk of developing abnormal cervical cells increases. So, you’ll be called back again in another year’s time to repeat the test again.

Having HPV and borderline or mild changes

If your test result says that you have cells with ‘borderline’ or ‘mild’ changes, you may need more tests. Although these mild changes rarely develop into cancer and may well return to normal by themselves, they need to be checked. You’ll be offered a further test called a colposcopy to look at your cervix more closely. This is usually within six weeks.

Having HPV and moderate or severe changes

If your test result says that you have cells with ‘moderate’ or ‘severe’ changes, it’s still very 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 be offered a colposcopy to examine your cervix and see if you do need treatment.

Treating abnormal cervical cells

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

If your screening test shows cells with moderate or severe changes, you’ll be asked to have a colposcopy. If your colposcopy shows an area of your cervix that looks abnormal, the doctor will take a biopsy. This is a small sample of the abnormal tissue that is sent to a lab to be examined.

Depending on the result, you may need to have treatment to remove or destroy the abnormal cells. The usual way to do this is with a large-loop excision of the transformation zone (LLETZ), also known as loop excision or loop diathermy. Your doctor uses 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.

Frequently asked questions

  • The aim of cervical screening 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.

    Infections that may show up include candida (thrush), herpes simplex 2 (a viral infection) and trichomonas (a tiny parasite). If your test suggests you may have an infection, your GP may offer you treatment.

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

  • The NHS currently invites women from the ages of 25 to 64 for cervical screening. These age limits are based on research. The NHS continues to monitor the latest evidence to check that these decisions remain appropriate.

    Research into the best age to screen for cervical cancer suggests that screening younger women can do more harm than good. In women under 25, cervical cancer is very rare, and screening doesn’t reduce the incidence.

    When you’re under 25, cervical cell changes are common but generally go away by themselves. If these changes are picked up, you could have treatment you don’t need. There are some important risks associated with screening and treatment.

    • If you are under 25 and have abnormal cells that would go away by themselves, screening could cause you unnecessary anxiety and worry.
    • A treatment for abnormal cells called loop excision can cause heavier and more painful periods afterwards.
    • If you become pregnant later in life, there is a higher risk of premature (early) birth. The evidence is mixed and it occurs only with some treatments, but it’s still an important to consider it. The loop excision treatment may also increase your risk of having a miscarriage.

    The screening programme stops at 64 because the tests aren’t as good at detecting abnormal cell changes later in life. After you reach 65, you’re far less likely to have abnormal cells and go on to develop cervical cancer. Most women over 50 who get cervical cancer haven’t attended all their screening tests in the past.

    Even if over 65, you will continue to be invited for screening until you have had three consecutive results that are negative for HPV and show no cell changes. If you haven’t had screening since you were 50, you can ask for an appointment.

    Whatever age you are, if you have symptoms like unusual bleeding, discharge or pain, contact your GP or local sexual health clinic. See our topic on Cervical cancer to learn more about the symptoms.

  • Yes, it is best to still go for your screening appointments.

    In the UK, girls and boys are now vaccinated against high-risk types of HPV at the age of 13. This will dramatically reduce the incidence of abnormal cells and cervical cancer (and other cancers) in the future.

    The vaccine protects against the types of HPV that cause more than 75% (three-quarters) of all cases of cervical cancer. However, it may not give you 100% protection against all high-risk types of HPV.



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  • Reviewed by Liz Woolf, Freelance Health Editor and Marcella McEvoy, Bupa Health Content Team, December 2019
    Expert reviewer, Dr Robin Crawford, Consultant Gynaecologist
    Next review due December 2022

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