Imogen Wellman-Brown- Nurse Colposcopist (contributor)
The national cytology screening programme (smears) commenced in 1964 with the aim of lowering the number of people who develop invasive cervical cancer and the number of people who die from it (Gov, 2020). It is estimated to save 5,000 lives each year (Jo’s Trust, 2020) and due to the success of the programme cervical cancer used to be the 4th most prevalent cancer in women but is now the 17th (smears really do work!).
I know nobody jumps and skips to these appointments, and let’s face it, it never fee
ls normal to be in a room with a stranger with only half your clothes on with your knees near your chin.
But what are we actually testing for and why is it important?
The continuous development of screening has seen the introduction of primary HPV screening in 2019 (Gov, 2020), the Human Papilloma Virus (HPV). This is a virus that over 80% of the population contract in their lifetime and through research has been proposed as the first ever identified cause of cervical cancer. As HPV DNA can be detected in adequate specimens of cervical cancer in 90–100% of cases (Bosch et al, 2002). The virus on its own is not an abnormality but it has proven to put you at risk of developing abnormal cells on the cervix which if these cells are left untreated could turn into cancer. Thus, testing for HPV will identify more women at risk of cervical cancer (PHE,2020) and prevent cancer from happening…I know right pretty clever.
But you might be asking well how do I contract HPV?
HPV is not a sexually transmitted disease and is spread through skin-to-skin contact, as easy as shaking hands. Research has led us to believe that once you contract HPV it goes through stages of being active and dormant within your body and when the virus is active it can be picked up on your smear test. Like any common virus like a cold, it tends to be active when you’re run down, stressed or your immune system is dampened. But unlike a cold, you don’t get any symptoms of HPV, and this is why you go for your smear to see if the virus is there.
Many wonder why on a previous smear they did not have the presence of HPV but this time they do. This is because of this ever-fluctuating pattern of the HPV being active and inactive therefore it isn’t always present. In addition, if your last smear was before 2019, HPV was not tested as a primary screening and, therefore would not have been reported on your last smear. No one can ever prove where and when you contracted HPV, and you are in the minority if you have never had it!
What happens if I have the virus?
The first thing to say is DO NOT PANIC! I know we are all guilty of thinking of worse-case scenarios, especially when you receive a letter saying your smear was ‘abnormal’. If your smear shows the presence of HPV but all your cells are normal you will be recalled to your GPs in 1 year for a repeat smear, this is because the virus on its own is not an abnormality, it just puts you at risk of developing abnormal cells, therefore we monitor annually instead of 3 or 5 yearly. We know that it takes on average 2 years to regress HPV (some people longer!) and monitoring yearly is a safe interval to make sure things are going in the right direction.
If you have 3 consecutive annual smears with the presence of HPV and no abnormal cells you will then go to colposcopy (fancy name for someone who spends all their day looking at the cervix….my full-time job) to have a closer look, this is to double check and an opportunity to look at cells which can’t be seen by the naked eye.
It is also important to remember If at any point your smear shows the presence of HPV and abnormal cells you will be invited to colposcopy for a closer look even if it’s your first ever smear or your last ever smear. Everyone is treated the same.
It is important to remember we are looking at pre-cancerous cell changes and the programme is there to prevent these abnormal cells from turning into cancer.
You might be wondering, what does colposcopy involve?
It is like having your smear taken it just takes a little longer. Skin solutions are then applied to the cervix which can help the Colposcopist identify any areas that mightshow the presence of abnormal cells and once they have looked at your cervix they then decide on management. This may be nothing, a repeat smear, a biopsy to help with a decision on management or treatment to remove the area where abnormal cells are seen. Not all abnormal cells need to be treated, as our bodies are very good are tackling them on their own, it all depends on the degree of abnormality to which is the best management to help these cells return back to normal.
So, what can you do to help?
Unfortunately, there is no treatment for HPV. We are very good at getting rid of abnormal cells, but it relies on our own immune system to suppress HPV. The vaccination programme against some strains of HPV has been introduced to girls in year 8 to help reduce the prevalence of certain strains of HPV with the aim to reduce the number of cervical cancers in future.
There is also a strong correlation between the persistence of HPV and smoking. Smoking dampens the immune system therefore takes longer to suppress or stops you from suppressing HPV which can therefore put you at an increased risk of developing abnormal cells. Everyone always thinks about smoking affecting the lungs but don’t forget how it can affect your cervix!
You may also be thinking why don’t we offer smears under the age of 25?
In 2013 the starting age for cervical screening was increased from 20 years to 25 years as cervical cancers under 25 are extremely rare and screening under 25 could do more harm than good and contribute to unnecessary treatment of the cervix (UK National Screening Committee, 2019). The screening programme is targeted at a population of people, not individuals.
Last but not least top tips to remember:
1. Always go for your smears when invited
2. Do not panic
3. You can keep your socks on
4. And you really don’t have to shave for us