Cervical Smear Tests

Although cervical cancer is the second most common gynaecological cancer it is almost totally preventable or treatable. Despite this around 1500 women in the UK die of it each year. Many of these women have not had regular cervical smear tests. Women who have a cervical smear test every three to five years are unlikely to develop cancer of the cervix because the test can identify women who are at risk of the disease before it starts.

What can cause cervical cancer?
Almost all women carry some risk of developing cervical cancer. The development of abnormal cervical cells probably results from several factors coming together at one time, with something triggering off the unhealthy growth. The same combination of factors is unlikely to happen again. Even if it did, the body’s defence mechanism may be able to deal successfully with the condition itself without medical help. The risk of developing cervical cancer is increased if certain risk factors are present:

Early age of first sexual intercourse
Cigarette smoking
Stress
A poor diet lacking in vitamins
Use of contraceptives that do not act as barriers
A large number of sexual partners or having a partner who has had many other partners
The presence of certain specific types of human papillomaviruses (HPV)
Infection with the AIDS virus (HIV)
What is a cervical smear test?
The cervical smear test checks for changes in the neck of the womb (the cervix) at the top of the vagina.

It finds early warning signs that cancer might develop in the future. If abnormal changes are found, further investigations (colposcopy) will be carried out to see whether or not treatment is needed.

The cervical smear test is not for diagnosing cancer but rather for finding early changes that might become cancer later. All women between the ages of 20 and 64 years are advised to have a cervical smear every three to five years.

The cervical smear test is a quick and simple procedure in which the doctor or nurse gently inserts an instrument called a speculum into the vagina. This allows the cervix to be clearly seen. You may feel a mild sensation when the cervix sample is being taken. It only takes a moment to do. It may be a little uncomfortable but it should not be painful. Relaxation can lessen the discomfort.

A small sample of cells is taken from the cervix and placed onto a glass slide. The slide is then sent to a laboratory where it is examined under a microscope. After the examination, there may be mild spotting of blood for that day. This is normal, but consult your doctor if the bleeding lasts longer or if you are worried. You should then get your results within 4 to 6 weeks by post.

Why is the cervical smear test necessary?
The cervical smear test can detect early changes in the cervix that may be the first warning signs that a problem is occurring. These changes need to be checked as some may develop into cancer. Your doctor will tell you whether treatment will be necessary. The purpose of having regular cervical smears every few years is to detect abnormal cell changes at a stage when they cause no symptoms, can be treated easily, and before they develop into a serious condition.

Most cancers of the cervix take ten to fifteen years to develop.

The cervical smear test results
When a smear test has been taken, the result is often not negative. An abnormal result can seem like the end of the world.

Inadequate
Sometimes the report will indicate that the sample was unsatisfactory with not enough cells for analysis due to the way the smear was taken or handled or treated in the laboratory. This may happen for a variety of reasons:

the cervix cells on the slide may have been obscured by blood or inflammation;
there may not have been enough cervix cells on the sample to give an accurate assessment;
the smear may not have been properly prepared; or A the slide may have been broken.
If any of these problems occur, you will be asked to have another cervical smear test a few weeks later.
Inflammation/Infection
Quite often, a cervical smear test will show that the cells of the cervix are slightly irritated, which may be due to an infection. You may need further tests and treatment for the infection.

An abnormal cervical smear test result
Currently in the UK, 1-2% of women aged 25-35 years will have an abnormal smear. It is most common within this age group, being extremely rare before the age of 15 years and falling off to 0.5-1% after 40 years.

With minor abnormalities, more regular cervical smear tests may be all that is needed for a period of time. For many women, minor changes will return to normal.

By having more frequent cervical smear tests, as recommended by your doctor, it is possible to monitor and check the cervix and that the changes have not progressed any further.

If you need further tests you will be referred to a hospital where you will be seen by a gynaecologist who is specially trained in diagnosing and treating abnormalities of the cervix. The technique used is known as Colposcopy.

Having an abnormal smear does not mean that you have cancer, or are going to develop it in the future.

Colposcopy

Colposcopy is an examination which shows where the changed cells are and what they look like.

Colposcopy involves no more than the doctor passing a speculum (like when you have the smear taken), and then using a modified microscope (colposcope) to look at the cervix. The colposcope does not come into contact with you and the doctor looks into it at the end of the couch. This magnification makes it easier to see all of the transformation zone of the cervix and look for any abnormal areas that might be causing the unusual cells on the smear. If an area looks abnormal, a tiny biopsy (sample) is taken - this is not particularly painful as the biopsy is so small. This allows the pathologist who looked at your smear to see exactly where the unusual cells were coming from. Knowing this the doctor doing the colposcopy can treat the abnormal area accordingly. Most treatments need no anaesthetic or only local anaesthetic and are carried out in the colposcopy unit. Treatment usually only takes about 20-30 minutes at most, and results in few after-effects. You will be asked to abstain from sex for 4 weeks or so.

Treatment

Laser treatment
Laser treatment takes only minutes and very efficiently removes the area of abnormal surface tissue on the cervix by focusing a very intense beam of light which vaporises it. As it can be directed very accurately, it doesn’t disturb the rest of the cervix. The treated area takes a few weeks to heal with new healthy tissues growing over the area. To try to numb possible pain, a local anaesthetic is used on the cervix before the treatment starts.

Cone Biopsy
The cone biopsy operation has been the standard treatment for abnormal cervical cells for many years. It is a minor operation to remove the part of the cervix with the abnormal area of surface tissue (roughly in a cone shape 1cm.deep). Since colposcopy has been available to locate exactly where the abnormal cells are, the operation can be accurately directed.

It involves being in hospital 3—5 days.

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