Cervical screening (Smear Test)

Purpose of Cervical Screening

Cervical screening is primarily performed to detect signs of cervical cancer or abnormal changes in cervical cells that could lead to cancer. It is a crucial preventative measure for anyone with a cervix.

Often conducted alongside a pelvic examination, this test may also include screening for HPV (human papillomavirus), a sexually transmitted virus responsible for the majority of cervical cancers. In some cases, a test for HPV may replace the smear test for screening purposes.

The decision on when to start cervical screening and how often it should be repeated depends on individual circumstances, which you can discuss with your medical professional.

Concept of cervical cancer

Cancer can be defined as the out-of-control growth of cells, which, in turn, invades other tissues of the affected area.

Cervical cancer results from cells in the cervix growing uncontrollably and invading nearby tissues. This process is usually triggered by mutations in the DNA of the cells. Factors that contribute to these mutations include lifestyle factors, infections, environmental exposure (e.g., pollution), and inherited genetic conditions.

Causes and risk factors

Cervical cancer is predominantly caused by persistent infection with high-risk strains of HPV, particularly types 16 and 18, which account for approximately 70% of cases worldwide.

Other risk factors include:

• Long-term use of contraceptive pills (over five years)

• A weakened immune system

• A family history of cervical cancer

• Smoking

• Having multiple sexual partners or becoming sexually active at a young age

• Exposure to diethylstilbestrol (DES) during pregnancy

Screening recommendations

Screening guidelines vary by age:

• After 65 years: Screening may stop if prior results have been consistently normal. However, consult with your medical practitioner for personalised advice.

• After 30 years: Co-testing every five years is typical, though some may opt for HPV testing alone.

• The 20s: Begin screening at 21 years; the test should be repeated every three years. Concurrent HPV and cytology screening may be introduced at 25 years and repeated every five years.

For those who have undergone a total hysterectomy (removal of the uterus and cervix) for non-cancerous reasons, cervical screening may no longer be necessary.

Risks of a smear test

While smear tests are a safe and effective screening tool, they are not infallible. False-negative results can occur, meaning abnormalities may go undetected. This could be due to:

• Washing away of cells due to douching or vaginal treatments

• An insufficient sample of cells

• The presence of blood or infection obscuring the cells

Since cervical cancer develops slowly, regular screening increases the likelihood of early detection in subsequent tests.

More frequent testing may be recommended for individuals with certain risk factors, such as:

• Exposure to DES before birth

• HIV infection or a weakened immune system

• A previous diagnosis of cervical cancer or precancerous cells

Preparing for the test

To maximise the effectiveness of your smear test, follow these recommendations:

Schedule the test when you are not menstruating. While it can still be performed during a period, it is best avoided unless necessary. Avoid sexual intercourse, douching, or using vaginal medications for two days before the test, as these could obscure abnormal cells.

What to expect during the testing process

The test is conducted in a clinical setting and typically takes only a few minutes. The patient will lie on an examination table with their feet resting in stirrups. A medical professional will gently insert a speculum to hold the vaginal walls open, providing a clear view of the cervix.

Using a small brush and spatula, they will collect cells from the cervix. While the process may cause mild discomfort or cramping, it is generally painless. The collected sample is preserved in a liquid solution and sent to a laboratory for analysis.

Collecting the results

You can resume your daily activities immediately after the procedure. Your healthcare provider will inform you when to expect the results, typically within 7 to 21 days.

Understanding the result

• Unclear result: Sometimes, results are inconclusive, requiring additional testing or a repeat smear test.

• Positive result: A positive result does not confirm cervical cancer but indicates the presence of abnormal cells requiring further investigation.

• Negative result: If no abnormalities are found, you will not need further tests until your next scheduled screening.

Common terms used in positive results include:

• SIL (Squamous Intraepithelial Lesion): Indicates possible precancerous changes. High-grade changes may require immediate attention, while low-grade changes often resolve on their own.

• Adenocarcinoma cells or squamous cell cancer: Strongly suggestive of cervical cancer, requiring urgent evaluation and treatment. The glandular cells are where Adenocarcinoma develops, while squamous cells originate on the surface of the vagina within the flats cells.

• Atypical glandular cells: Abnormal glandular cells may necessitate further tests to rule out cancer.

• ASC-US (Atypical squamous cells of undetermined significance): These cells appear abnormal but are not necessarily precancerous. HPV testing is often recommended in this case by the medical practitioner. If any risks are spotted, you may be required to undergo further testing.

If concerning results are identified, colposcopy may be performed. This procedure involves examining the cervix under magnification to identify abnormal areas for biopsy.

Take Action

Cervical screening is an essential part of maintaining reproductive health. Contact ust****oday to schedule your smear test or discuss any concerns.