Cervical cancer screening
This page is about screening for cancer of the cervix. You can find information on
Cervical cancer screening
Cervical screening is very important because we can stop cervical cancer from developing. This is one of the few cancers that is preventable because pre-cancerous cell changes can be picked up before they have a chance to develop into cancer.
The screening test is called a cervical smear. A nurse or doctor takes a small sample of cells from the surface of your cervix, by putting an instrument called a speculum inside your vagina then scraping the cervix with a small brush. The cells are put into a liquid and sent to the laboratory.
Who is screened?
If you are between the ages of 25 and 60 in the UK, you will be contacted at least every five years and asked to come for a cervical screening test. The age that screening starts and finishes varies between the different countries of the UK.
Smear test results
The smear test picks up pre-cancerous changes. If you have an abnormal result, it does NOT mean you have cervical cancer. But you may need further tests or treatment for an abnormal smear.
Cervical screening is very important because we can stop cervical cancer from developing in the first place. This is one of the few cancers that is preventable because pre-cancerous cell changes can be picked up before they have a chance to develop into a full blown cancer. Screening has been available in the UK since 1967.
The screening test is often called a cervical smear. A nurse or doctor takes a small sample of cells from the surface of your cervix and puts them into a pot of liquid. This is called liquid based cytology. When it reaches the lab, your sample is put under a microscope. The cells are examined and any abnormal ones reported.
Cervical smears used to be spread straight onto a glass slide. This was called a PAP smear. For women having the test, it was much the same. You may still hear people talking about PAP smears.
If you are between the ages of 25 and 60 in the UK, you will be contacted at least every five years and asked to come for a cervical screening test. The exact age groups for screening vary between the different countries of the United Kingdom. In England, women between 25 and 64 years are screened. In Northern Ireland and Wales, women between 20 and 64 are screened. In Scotland, women between 20 and 60 should be screened every 3 years. There is information about why the screening age varies further down this page.
The screening interval is the time between smears. In other words, 3 or 5 years. This used to vary between health authorities. But research reported in 2003 by Cancer Research UK showed that the screening interval should be decided by age. We can pick up the most cancers by screening women 3 yearly if they are 25 to 49 years old and 5 yearly if they are between 50 and 64. So the guidelines for England have now been changed.
For women between 25 and 49, 3 yearly screening prevents 84 cervical cancers out of every 100 that would develop without screening. 5 yearly screening will only prevent 73 cancers out of 100. That is why the guidelines now recommend screening women 3 yearly if they are under 50.
It is acceptable and safe for women of 50 or more to have 5 yearly smears. Screening 3 yearly doesn't give any extra protection for this age group. This is probably because abnormal cells develop more slowly in women over 49.
The NHS in England have now adopted these recommendations. So if you are between 25 and 49 and live in England, your health authority should be offering you 3 yearly cervical screening.
You can have a smear test at
- Your GP surgery
- A well woman clinic
- A Family Planning Clinic
- A genito-urinary Clinic (clinic for sexually transmitted diseases)
- An antenatal clinic if you are pregnant
- A private health clinic
- A voluntary organisation clinic, such as Marie Stopes
You can ask for a female nurse or doctor to do your smear test. All clinics will have women available to chaperone a male doctor. But if you only want a woman to take the smear, you may have to make an appointment to come back. So if you are concerned about this, it is best to mention it when you originally make your appointment.
Remember - you should try to make your smear appointment for the middle of your menstrual cycle. In other words, between periods. It is more difficult for your doctor to see the cervix and take a smear if you are having a period when you go. You may get an inadequate result and have to come back for another smear test.
You take off your underwear and lie on your back on a couch. You have to lie with your knees drawn up and spread apart. If this position is difficult for you to get into, you can ask your nurse to take the smear when you are lying on your side with your knees drawn up.
A smear test might be a little uncomfortable because of the position you have to get into. It shouldn't hurt. It can be more uncomfortable if you are very tense. Try to relax. Taking a few deep breaths should help. Breathe in and out deeply through your mouth several times.
To make sure that the womb feels a normal size and is in the right position you may need a vaginal examination. Your doctor will not necessarily do this every time you have a smear test. The doctor or a specially trained nurse puts on a disposable glove and puts two fingers inside your vagina. Then, with the other hand, the doctor or nurse presses down on your abdomen gently to feel your womb.
To take the smear, the doctor or nurse puts an instrument called a speculum inside your vagina. The speculum has two arms that spread the sides of your vagina apart so that the doctor or nurse can see the cervix clearly. Then the surface of your cervix is scraped with a small brush. This collects a sample of skin cells from the cervix. As soon as the nurse takes the sample, she will put them into a pot of liquid, and send them to the laboratory. The test is then over and you can get down from the couch.
The NHS screening programme now uses liquid based cytology (LBC) to preserve the cells taken in smear tests. The nurse collects the cells from the cervix using a very small brush. The head of the brush is broken off into a small pot of liquid, or the cells rinsed off into the pot, instead of putting the cells onto a slide, as used to be done with a PAP smear. The cells are better preserved with LBC, so the results of the smear test are more reliable. In the NHS pilot, only 1 or 2 out of every 100 tests (1 to 2%) had to be repeated with LBC, compared to 9 out of 100 (9%) when smears are put straight onto slides. So you are less likely to be called back to have the smear done again with LBC.
Liquid based cytology has now been brought in for cervical screening throughout the UK.
The lab will automatically send the results back to the surgery or clinic where you had the test. Your surgery may not contact you if the smear is normal. But they should if there is anything wrong. Or if the smear could not be read properly for some reason. Just to make sure, it is best to contact your GP or clinic for your own result. Ask when the results should be back. Then you can ring if you haven't heard.
There are several different results you can have after a smear. Some of them are about reading the smear, rather than cervical cancer. You could be told you need a repeat smear because yours could not be read properly (sometimes called having an 'inadequate smear'). This could be because
- Not enough cells were in the sample
- You have an infection which meant the cells could not be seen clearly enough
- You were having a period and there is too much blood to see the cells clearly
- The cervix was inflamed and so the cells could not be seen clearly enough
In all these cases, you will just be asked to go back and have another smear. If you have an infection, you will be given some treatment and then asked to have another smear in a couple of months.
You may be told your smear result was 'borderline'. This means that cell changes were seen but that they were so near normal that they are probably nothing to worry about and will go back to normal on their own. You will need to go for a repeat smear (probably in 6 months), but won't need any more tests unless your repeat smear shows that the cell changes are still there or have got worse.
This is a condition often picked up on smear testing. You may hear it called an ectropion. It has nothing to do with cervical cancer. It means that glandular cells, which are only normally seen inside the cervical canal, can be seen on the surface of the cervix. The cervix often looks a little inflamed in this area. An erosion is nothing to worry about. It is common in teenagers, in pregnancy and in women on the pill. It can cause slight bleeding, especially after sex. Usually the condition goes away by itself without any treatment.
Abnormal smears can be reported in two different ways. If you have abnormal cells you may be told you have
- Mild or slight cell changes (mild dyskaryosis)
- Moderate cell changes (moderate dyskaryosis)
- Severe cell changes (severe dyskaryosis)
Your smear test result may say CIN 1, CIN 2, or CIN 3 instead of mild, moderate or severe. CIN stands for cervical intraepithelial neoplasia. This just means cervical cell changes. This classification is not strictly accurate as CIN can only really be diagnosed with a biopsy. But the smear results do indicate that you probably have
- CIN 1 if you have mild cell changes
- CIN 2 if you have moderate cell changes
- CIN 3 if you have severe cell changes
The three grades of CIN relate to the thickness of the skin covering the cervix that is affected. CIN 1 means one third of the thickness of the skin covering the cervix has abnormal cells. CIN 3 means the full thickness of the skin covering the cervix has abnormal cells. Both the level of cell abnormality (mild, moderate or severe) and the CIN level will be taken into account when deciding whether you need treatment.
All these results mean that cells have been found on your smear that were pre-cancerous. This does not mean you have cervical cancer. It means that some of the cells were slightly abnormal and that if they were left untreated, they could go on to develop into cervical cancer.
Remember - we are talking about the smear test as screening for cervical cancer here. Screening means testing healthy women. If you have symptoms of cervical cancer, you may be given a smear test as part of the tests used to investigate your symptoms. This is a very different situation to having the smear as a screening test.
If you have mild cell changes or CIN 1 your doctor will either suggest a colposcopy straight away or ask you to come back for another smear in 6 months time. Sometimes these slightly abnormal cells can go back to normal by themselves. But you should definitely go for your repeat smear. You can't assume that the cells will go back to normal. If your next smear is abnormal, will then definitely have a colposcopy to check it out further. You may need some treatment.
If the next smear is normal, you will still need a further smear in 6 months. The NHS guidelines say that you should have three normal 6 monthly smears, one after the other, before it is safe for you to go back to regular screening.
If you have moderate or severe cell changes, or CIN 2 or 3, you will need treatment to get rid of the abnormal cells. There is more about treatment for an abnormal smear in this section of CancerHelp UK. You usually only need treatment once. Then you have follow up smears. If you do have an abnormal smear and have successful treatment you are very unlikely to get cervical cancer (provided you continue being screened). If you do not have treatment, you are very much at risk from cervical cancer.
(CIS)
CIN 3 is sometimes called 'carcinoma in situ'. This sounds like cancer, but it isn't. It means that some of the cells look cancerous. But they are all contained within the skin covering the cervix. It will not be a true cancer until the cells break through the top layer of skin covering the cervix and spread into the tissue underneath. If this happens, the cells can spread and then they will become a true cancer. You must have treatment as soon as possible if you have carcinoma in situ. As long as the affected area is removed, cancer can be prevented.
9 out of 10 smear results are normal. About 1 in 20 shows borderline or mild cell changes. In most of these women, the cells will go back to normal by themselves. So the women will usually have repeat smears every 6 months until they do. They will only go on to have treatment if the cells don't go back to normal.
1 in 100 smears shows moderate cell changes. 1 in 200 shows severe changes. These women will go on to have colposcopy to investigate further.
Less than 1 in 1,000 smears shows an invasive cancer. These women are sent straight to a specialist.
You are bound to have heard various news reports in the past about women being recalled for smear testing because the system went wrong. And even some women dying from cervical cancer because their smears were not checked properly and so they missed out on the treatment they needed.
But don't let this put you off! The women affected had abnormal smears that were missed. This should not happen. But it wasn't the smear test that made them ill. In fact, it was as if they hadn't had smear tests. They developed cervical cancer that should have been prevented. As a result of these few mistakes, the system has been tightened up even further. Rather than miss out on your smear test, reassure yourself by asking your nurse or doctor how smears are checked in your health authority.
At the moment all the samples are examined in the laboratory by trained technicians looking down microscopes. Because people make mistakes, two different people should now check all smear tests. The scare stories in the past were all in health authorities who didn't make sure two people checked their samples. And in some cases because technicians were not trained or supervised properly. If you are worried, ask whoever takes your smear whether smears are double checked in your health authority. And what training the technicians receive. If they don't know, ask them to find out and let you know.
Lastly, always make sure you get your result. If you do not get the result, there is always the tiny chance that the smear was reported as abnormal but that this result was not sent back to you or your GP.
The original cervical cancer screening programmes across the UK screened women from 20 to 64. The screening programme in England now starts at 25 because cervical cancer is very rare before this age. But changes in the cervix are quite common in younger women. So screening younger women can lead to unnecessary treatment and worry.
There is still more evidence coming in about the exact age groups we should screen. In Wales, Scotland and Ireland, they are still screening from age 20 until more evidence comes in, including from their own screening programmes. Another complication is that liquid based cytology has been introduced over the last few years. If you make more than one major change at a time to any health programme, you won't necessarily know which change is responsible for improvements in your service. In Wales, for example, they decided to stick with the original screening age, and introduce LBC fully before making any more changes.
Just make sure you begin having regular smears as soon as you are 25 if you are sexually active. If you are under 25 and are at all concerned, talk to your GP or go to a well woman clinic.
The screening programme stops at 64 because women who have had normal smears are very unlikely to go on to develop cervical cancer after this age. The Department of Health guidelines say that if your last 3 smears were normal when you are 64, there is no need to have any more. But many older women have not had enough smears. One of the reasons the cervical smear programme has not cut the number of cases of cervical cancer as quickly as it should is because there are so many older women who have never had smears.
So, if you are over 64 and your last 3 smears were normal, you will not be asked to come and have any more. If you are over 64 and have had abnormal smears, you will continue to be invited for regular smears in the normal way.
If you have never had a smear, you should have one done regardless of your age unless you have never been sexually active. Ask at your GP surgery or well woman clinic.
Remember - if you are over 64 and have not had 3 normal smears in a row, you should carry on having regular smear tests until you do. Make sure you ask at your GP or well woman clinic if you think you should continue to have regular smears.
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