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Everything you need to know about cervical screening but were too embarrassed to ask

Everything you need to know about cervical screening but were too embarrassed to ask

Emma Hammett A qualified nurse, author and first aid trainer with over 30 years’ healthcare and teaching experience Cervical Screening Awareness Week aims to highlight the importance of regular cervical screening for women’s health. It’s an annual event – which runs from 10th to 16th June 2019 this year  – and is organised by Jo’s

Emma Hammett A qualified nurse, author and first aid trainer with over 30 years’ healthcare and teaching experience

Cervical Screening Awareness Week aims to highlight the
importance of regular cervical screening for women’s health. It’s an annual
event – which runs from 10th to 16th June 2019 this year  – and is organised by Jo’s Trust, a charity
dedicated to women affected by cervical cancer or abnormalities.

Cervical cancer – the statistics

Cervical cancer is one of the most deadly but most
preventable forms of cancer in women. It is the most common cancer in women
under 35.  It kills two women every day
in the UK.

Screening pays off

However, regular cervical screening appointments can prevent
up to 75% of instances of cervical cancer. Furthermore, a considerable 5000 lives
are saved per year, thanks to screening and early treatment.

The best protection

Cervical screening – smear tests – is the best protection
against cervical cancer.

It detects cell changes, which left untreated, could later
develop into cancer.

It’s not a test for cancer – it’s a test to help prevent
cancer.

About 1 in 20 people will have an abnormal result after
cervical screening – about 220,000 women every year.

Put simply, this is a life-saving test.

Why don’t 25% of women respond to their screening
invitation

Despite this, many women are reluctant to have this screening
test. In fact a quarter of women do not respond to their screening invitation.

And this figure increases to 1 in 3 when looking at the 25
to29-year-age group.

In fact, recent NHS figures show attendance has plummeted to
71%. This suggests about three million women across England haven’t had a smear
test for at least three and a half years.

Furthermore, screening rates are at their lowest for about
20 years and Public Health England are ‘concerned’ by this fall.

The embarrassment factor

It seems may women feel embarrassment about taking the test.
 This was confirmed by a survey of more
than 2000 women in the UK by the charity Jo’s Cervical Cancer Trust. The survey
results revealed that out of the 2000 women 900 had either delayed or not
attended screening – with 81% of them citing embarrassment as the reason.

Common causes of embarrassment

The survey found that women were worried about their body
shape, the shape of their vulva, and their odour being ‘normal.’ Others
admitted they wouldn’t attend a screening test because they hadn’t waxed or
shaved their bikini area.

Others cited reasons such as not knowing where to get the
test, that it was too hard to make an appointment or they didn’t want to take
time off work or miss the gym. Some of the non-attenders admitted they would
rather just not know if something was wrong.

The survey also highlighted a lack of understanding
about the role of screening with:

61% of women aged 25 to 35 being unaware they were in the
highest-risk group for cervical cancer

37% believed screening didn’t reduce your risk of disease

24% believed they weren’t at risk because they were healthy

17% thought smears were important but couldn’t say why

11% thought you didn’t need a smear if you’d had the HPV
vaccine

Despite these reasons cited for not attending a cervical
screening appointment, almost all of the women in the survey – 94% – claimed
they would have a free test to prevent cancer if it was available.

Successful campaign

The campaign in 2009 led by the late Jade Goody –the TV star
who died 10 years ago from cervical cancer aged 27 – increased numbers attendance
by around 400,000 women. However, participation rates have fallen back since.

New test they call a game changer

Tests which are not invasive and don’t require a physical
test with a speculum are being trialled. One trial found urine testing was as
good at detecting a virus called HPV –which is a big risk factor for the
cancer.

Could the new urine test
increase screening participation?

Researchers at the University of Manchester asked 104 women
attending a colposcopy clinic to try the urine test. The results showed it
performed just as well as conventional smears for detecting high-risk HPV.
Researchers hope that the simple and discreet urine test may significantly
increase participation rates for screening. However, larger trials will be
needed before the test is recommended by the NHS.

What does a smear test do?

A smear test checks
the health of your cervix.

The cervix is the
opening to your womb from your vagina.

During the screening appointment, a small sample of cells
will be taken from your cervix which is tested for any changes.

If there are any abnormal cell changes in your cervix – left
untreated, could turn into cancer. However, early monitoring and treatment can
mean they don’t get a chance to turn into cervical cancer.

What is HPV?

Human papillomavirus
(HPV) is the name for a very common group of viruses.

You can get it from any kind of skin-to-skin contact of the
genital area, not just from penetrative sex.

Most people will get some type of HPV during their lives. Some
types of HPV can lead to cell changes in your cervix and cancer. Nearly all cervical
cancers – 99% – are caused by infection with certain types of HPV.

Since 2008, the HPV vaccine has been offered to girls aged
11 to 13 and reported cases of HPV have fallen sharply since then.

Currently 85% of eligible girls are immunised and HPV
vaccine rates in England are among the world’s highest.

A new HPV vaccine is also expected to be introduced which
should have a 90% success rate – up from 70% for the current vaccine.
Researchers believe women treated with this new HPV vaccine will only need two
smear tests in their lifetime.

Of the 900 deaths per year Public Health England says almost
all of them are older women who did not benefit from the HPV vaccination
programme.

Who needs to have the cervical screening and how often?

All women and people with a cervix aged 25 to 64 should be
invited by letter.

  • Those under 2 will be invited up to 6 months
    before you turn 25
  • Those aged 25 to 49  will be invited every 3 years
  • Those aged 50 to 64  will be invited every 5 years
  • Those over 65 or older will be invited  – only if 1 of your last 3 tests was abnormal.

Cervical screening is
not considered necessary

  • if
    you’re under 25 because cervical cancer is very rare in people under 25
  • if
    you have had a total hysterectomy which removes all of your womb and cervix.
  • if
    you’re 65 or older because it’s very unlikely that you’ll get cervical cancer

If you’re 65 or older and have never been for cervical
screening, or have not had cervical screening since the age of 50, you can ask
your GP for a test.

Do I need cervical
screening if I’ve never had sex?

If you’ve never had any kind of sexual contact with a man or
woman your risk of developing cervical cancer is very low. Therefore, if you’ve
never been sexually active you could choose not to be screened when you are
invited.  But you can still have a test
if you want one.

Sexual contact includes: vaginal, oral or anal sex,
skin-to-skin contact in the genital area, sharing sex toys.

However cervical screening is still recommended and
you are still at risk of cervical cancer if:

  • you have had the HPV vaccine – it does not
    protect you from all types of HPV, so you’re still at risk of cervical cancer
  • you have only had 1 sexual partner – you can get
    HPV the first time you’re sexually active
  • you have had the same partner, or not had sex
    for a long time –it is possible to have HPV for a long time without knowing it
  • you’re a lesbian or bisexual – you’re at risk if
    you have had any sexual contact
  • you’re a trans man with a cervix
  • you have had a partial hysterectomy that did not
    remove all of your cervix

However don’t wait for your cervical screening invite
if you

  • have bleeding between periods,
  • have bleeding during or after sex,
  • have bleeding after the menopause
  • or unusual vaginal discharge

Potential risks of cervical screening

It is possible you may have some light bleeding or spotting
after your cervical screening. This is common and should stop within a few
hours.

What you can do to prepare for the test

  • wear something you can leave on during the test
    such as a long jumper or a skirt
  • bring a friend or family member with you for
    support
  • try breathing exercises to help you relax
  • ask the nurse to use a smaller speculum
  • bring something to listen to the test
  • do talk to the nurse if you are feeling
    embarrassed or scared so they can reassure you and offer support

During the test

The test itself should take less than 5 minutes. The whole
appointment should take about 10 minutes.

1) You’ll need to remove all clothing from the waist down.
This is done behind a screen.

2) The nurse will ask you to lie back on a bed, with a sheet
over you.

3) Although you may need to change position during the test
its usually with your legs bent, feet together and knees apart. Do talk to your
nurses about finding a more comfortable position. Some people find it easier
lying on their side hugging their knees to their chest.

4) Using a small amount of lubricant, the nurse will gently
put a smooth, tube-shaped tool called a speculum into your vagina. The speculum
is then opened so the nurse can see your cervix.

5) A soft brush is used to take a small sample of cells from
your cervix.

6) The speculum is removed and you can get dressed again.

Results

Results arrive generally by letter, usually in about 2
weeks.

However, sometimes you may be asked to call your GP surgery
to get the results.

Try not to worry if there is a delay in your results
arriving – most people will have a normal result.

Your results
explained – see
https://www.jostrust.org.uk
for more details.

Normal result: Most
people will have a normal result – you don’t need further tests and your next
screening invite will be in three or five years.

Inadequate result:
Sometimes the results couldn’t be read properly so although you’ll be asked to
come back in 3 months to have the test again.

Abnormal result: You
may need any of the following and your letter should make it clear which course
of action you need:

  • no treatment
  • a further cervical screening test in 12 months
  • an additional test to look at your cervix called
    a colposcopy

Your abnormal results
explained

An abnormal result
may show borderline or low-grade
cell changes. These changes are very close to being normal and may disappear
without treatment.

However, in some areas of England and in Northern Ireland,
your sample will additionally be tested for high-risk human papillomavirus
(HPV) if these cell changes are seen.

Your letter will tell you what to do:

If no HPV is found,
you can go back to routine screening and you’ll be invited for screening again
in 3 or 5 years.

If HPV is found,
you will be invited to colposcopy where an expert will take a closer look at
your cervix.

Or an abnormal result may show high-grade (moderate or severe) dyskaryosis. This means you will be
invited to colposcopy, where an expert will take a closer look at your cervix.

Dyskaryosis
refers to the change of appearance in cells that cover the surface of the
cervix.

If you live in an
area where your sample is first tested for high-risk HPV:

HPV result
unavailable or unreliable:
This means that a true result could not be given
and you will probably need to have the test repeated after three months.

No HPV found (HPV
negative):
If you don’t have high-risk HPV, your sample won’t be tested for
cell changes  – abnormalities – as it is
very unlikely you would have or develop them. You will be invited for cervical
screening again in 3 or 5 years, depending on your age.

HPV found (HPV
positive) but inadequate:
You usually you need to repeat the test after 3
months because the first one couldn’t be read properly. This may be because the
sample didn’t have enough cells, or the cells could not be properly seen.

HPV found (HPV
positive) but no cell changes found:
Your immune system usually gets rid of
HPV. You will be invited for cervical screening again in 1 year, to check that
the HPV is gone.

If you have 3 HPV positive results in a row, you will be
invited to colposcopy.

HPV found (HPV
positive) and cell changes found:
Changes to the cells may be: borderline or low-grade changes
(dyskaryosis)or moderate or severe (high-grade) dyskaryosis.

What is a colonoscopy?

If you results show
you need a colposcopy –
this is a simple procedure to look at your cervix –
similar to having cervical screening – but it’s carried out in hospital.

If abnormal cells are
found and you need treatment, there are some risks, such as:

  • treating cells that may have gone back to normal
    on their own

Myth – if you get a positive HPV result it means you
partner has had sex with someone else

A positive HPV result does not mean your partner has had sex
with someone else. You could have HPV even if you have not been sexually active
or had a new partner for many years.

The costs to the NHS

As well as the cost to our health and wellbeing in not
attending cervical screening, Jo’s Cervical Cancer Trust https://www.jostrust.org.uk

estimates that treating early-stage cervical cancer is
around 14 times less expensive then treating later-stage cervical cancer.

What to expect during Cervical Screening Awareness
Week

Expect information stands at GP surgeries, workplaces and
sports centres. There will be fundraising events to support and look out for a
social media campaign with women sharing their stories regarding cervical
cancer and screening.

Further support from the Cervical Screening Programme

If you’re not sure whether to have cervical screening, talk
to your GP or nurse.

For more information about being invited for cervical
screening, getting your results and opting out, you can contact the Public
Health England (PHE) screening helpdesk by: calling the helpdesk on 020 3682
0890 or

emailing phe.screeninghelpdesk@nhs.net

For further information here: https://www.jostrust.org.uk or https://www.nhs.uk/conditions/cervical-cancer/

Written by Emma Hammett, CEO of First Aid for Life

Book a first aid course now – the skills you learn could
equip you with the knowledge to save your child’s life! https://www.firstaidforlife.org.uk

First Aid for Life is a multi-award-winning fully regulated
and Ofqual approved first aid training company. www.onlinefirstaid.com are the
leading UK online first aid training providers to allow you to learn these
vital skills when it suits you

Emma Hammett

Emma Hammett

Emma Hammett is a qualified nurse, author and first aid trainer with over 30 years’ healthcare and teaching experience.

Emma is the Founder of three multi-award-winning businesses; First Aid for Life, Onlinefirstaid.com, First Aid for Pets and her social cause StaySafe.support. She has published multiple books and is an acknowledged first aid expert and authority on accident prevention, health and first aid. Emma writes for numerous online and print publications and regularly features in the press, on the radio and on TV.

She is the first aid expert for the British Dental Journal, British Journal of School Nursing, the Mail online and Talk Radio with Eamonn Holmes. She is a member of the Guild of Health Writers and Guild of Nurses.



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