Cervical cancer Q&A

 

Cervical CancerAlthough cervical cancer is a largely preventable disease, every day eight women in the UK are diagnosed and face an unsure future, and three women die from it. A widely available screening system is saving some 4,500 lives a year, and it's vital to be aware of all the symptoms that indicate any changes in the cervix. 

If you're unsure what the symptoms are, are worried about your chances of contracting cervical cancer or have been diagnosed and want to know more about a referral or treatment, read the answers to the questions you asked in our discussion thread.

HPV | Prevention and screening | Vaccination | Education | Cervical abnormalities | Cervical cancer


HPV

Letter QJoolyjoolyjoo: I had cervical intraepithelial neoplasia (CIN) 2 cells two years ago, after always having completely normal smears. I have been with my husband for 10 years, and neither of us has strayed (he swears!) so how could I have suddenly developed HPV? Is it possible that either of us could have had the virus for so long, or should I be doubting his claims of fidelity?

Letter ADr Anne Szarewski: It can certainly take ten years or more for CIN 2 to develop after an infection with HPV. Cervical smears can miss abnormal cells, especially if the area is small, that is why you have smears at regular intervals. Since we know that it takes at least ten years for cancer to develop, the idea behind the screening programme is that you would have had at least three smears in that time and it is unlikely the abnormality would be missed by all of them. And that is what happened in your case, so screening has picked up the abnormality in time.
 

Letter QFrenchbulldog: Do spermicides kill any or all of the HPV viruses? Especially if used with barrier contraception such as a condom?

Letter ADr Anne Szarewski: Unfortunately, HPV is a very hardy group of viruses and spermicides don't kill them. They even survive freezing at -70 degrees.
 

Letter QBelaLugosilSDED: HPV is a bit like chickenpox, you can catch it from non-sexual contact and it can hang around for years. Most people have had HPV at some point in their lives and most clear the infection. In some, the body doesn't clear the infection as well. It's thought to take at least 10 years for CIN to develop so an abnormal smear test doesn't mean (necessarily) a recent HPV infection...

Letter AJCCT Team: Human papillomavirus (HPV) is an extremely common virus. At some point in our life most of us will catch the virus. The world over, HPV is the most widespread sexually transmitted infection: 80% (four out of five) of the world's population will contract some type of the virus once. If you catch HPV, in the majority of cases the body's immune system will clear or get rid of the virus without the need for further treatment. In fact you may not even know that you had contracted the virus.

Anybody who has ever been sexually active is at risk of contracting HPV. Genital HPV is transmitted primarily by genital-to-genital contact, anal intercourse and occasionally oral sex. The time from exposure to the virus to the development of warts or cervical disease is highly variable and the virus can remain dormant in some people for long periods of time. Often it is not possible to determine exactly when or from whom the infection originated. Practising safe sex through the use of condoms can help reduce the risk of being infected with HPV but it will not completely eradicate the risk as HPV lives on the skin in and around the whole genital area.
 

Letter QFrenchbulldog: So holding hands can give you cervical cancer?
 

Letter ADr Anne Szarewski: HPV is transmitted through skin-to-skin contact. Holding hands is not likely to transmit cervical cancer, but certainly genital–to-genital contact, without penetrative sex, could transmit HPV.
 

Letter Qstarbellysneetch: To what extent does the number of partners one has had earlier in life impact on one's chances of developing cervical cancer post-35?

Letter ADr Anne Szarewski: This really just depends on how likely you are to have caught HPV. You could have just one partner and be unlucky, or you could have 20 and not catch it. So the number of partners just reflects the increasing chance of catching HPV.

 

Prevention and screening

Letter Qreadinginsteadnowisundeadnow:What should I be doing to help myself, other than having a smear when it's due?

Letter Qchampagnesupernova: I know all about making sure I have regular smears - even though I dread them - but what else can I be doing to prevent cervical cancer?

Letter ADr Anne Szarewski: Smoking is a risk factor for cervical cancer, probably because it affects the immune system and allows an HPV infection to become persistent (ie not cleared). So not smoking is certainly a good idea. Having the HPV vaccine, even if you are over the age of the school vaccination programme, may offer protection. It has been shown that women who have been exposed to HPV in the past can still benefit from vaccination, though the degree of protection may not be as high, so you should continue to have smears.

Letter AJCCT Team: If you are above the age that covers the national vaccination programme, you will not be able to get the vaccine on the NHS, but you can certainly get it privately. Boots are selling it at £99 per injection, so just under £300 for the course. That is probably the cheapest way, and Lloyd's Pharmacy also offer the vaccine at a similar price. 

Letter Qsnowmash: As a disabled woman, what alternative positions can you ask to have a smear in, and where can I find good information on them to give to professionals? I haven't had as many smears as I should because education on this seems to vary. 

Letter ADr Anne Szarewski: You can have a smear lying on your side, rather than on your back. Often, though, it is just a case of allowing more time and being very careful and gentle. I don't know of any specific information, but I would advise you to tell the clinic about the problem and make sure the person who is going to do your smear has had experience with disabled people.
 

Letter Qmarsedotes: Why aren't women allowed to have a smear test before they are 25? If a woman is sexually active from 16 she will have to wait nine years before having one. I read that it was unadvisable to have one before 25 as it would "do more harm than good" - can anyone explain that, please? 

Letter ADr Simon Moore: In England, women are unable to have smear tests under the age of 25 on the NHS. Currently, in Scotland, Wales and Northern Ireland it is from 20 years of age. Northern Ireland are increasing the age to 25 from January 2011 and it is currently under review in Scotland. Privately in the UK they are offered by most doctors from the age of 20 years depending on when the woman became sexually active.

One of the problems is that smear tests can be difficult to interpret in younger women and the concern is, therefore, that some women will undergo invasive procedures unnecessarily. Recent research has indicated that cervical abnormalities are common in women under 25, most of them go away over time and do not develop into cancer and that those few cervical cancers that do develop in women under 25 may not have been prevented by screening.

The most important thing for women under the age of screening is to be conscious of any unusual symptoms - bleeding between periods and/or after sexual intercourse, unusual/unpleasant vaginal discharge, discomfort or pain during sex, lower back pain.

If you experience any of these symptoms, you should book an appointment with your GP immediately. These symptoms can be due to other, less serious conditions but should still be checked out. There are also now GP guidelines in place for younger women to ensure that they receive the correct care when experiencing these types of symptoms and you can view these here. 

Letter QMIssAnneThrope: How do the current NHS levels of screening for cervical cancer compare with other countries? In other words, should we be screened more regularly, and earlier age-wise than the NHS currently screens?

Letter ADr Anne Szarewski: Very few countries offer a free screening programme. In the majority of countries, women pay for their smears, or they pay for health insurance which covers the smears. A screening programme is very expensive, so it is works on a 'greater good for the greater number' principle. In countries where women pay for smears, they can have them at a younger age (though under 20 is not a good idea) and more frequently. The level of protection is higher, though not hugely greater, with two-yearly rather than three-yearly smears. Annual screening has not been shown to give more protection than two-yearly screening.
 

Letter Qunwind: Surely testing for HPV, rather than such frequent smears ought to be an option?
Smears are horrible experiences for many women, perhaps especially for those who may have birth trauma. I know that the HPV test process for women is much the same as the standard smear, but I understand that it needs to be done much less often. A high proportion of women over 35 never have sex (>25%). Of those who are, they are often in long-term monogamous relationships, with someone that they trust.

If you do not believe that you at are any risk of catching HPV, surely testing in case you've already caught it, and then testing again five years later, if there has been some chance of exposure, would be a better use of resources, and would minimise the stress caused to those women who are at very low risk. Perhaps men could be included in regular HPV testing, so they know if there is a risk of them passing it on.

Letter ADr Anne Szarewski: In the future, it is likely that some alternative to smears will be used. Unfortunately, the HPV tests we have at the moment don't tell you how long the infection has been present, and most HPV infections just come and go on their own, like a cold. It's only if the HPV infection is not cleared by the body that it becomes dangerous. So, particularly at younger ages, a lot of women would test positive, but it doesn't mean anything. And then they are worried for no reason.

HPV testing does lend itself to self-sampling, which means you can do the test yourself, without the need to go to a clinic and have an examination with a speculum. The majority of women would certainly prefer that, and I do hope that we will be able to move to something like that fairly soon, if we can just find a test that is more accurate.

You are right, in that if the HPV test is negative, the woman is at very low risk of getting cervical cancer and the interval between tests could be lengthened to at least five years, maybe more. The problem is for those women with the 'false positive' tests. Also, in this context, bear in mind that we have no 'treatment' for a positive HPV test ie we can't say 'use this cream / take this pill and it will go away'. Women who test positive, but have no abnormality that can be found on their cervix at the time, are just left to live with their uncertainty.

I'm afraid that HPV can be present, but undetected, for several years, so even if a person has not had sex for a while that doesn't mean they are not at risk.

With regard to your last point, there isn't currently a reliable HPV test for men, so that isn't an option. It is much harder to detect the virus in men than women, and it will take a while before we have a test that can be relied upon.

Letter AJCCT Team: Recent studies suggest that the over-45s are showing the greatest increase in all sexually transmitted infections.
 

Letter QBelaLugosiISDED: Do you favour HPV test as the primary screen, do you think it's useful as triage for low-grade abnormalities and for test of cure?

Letter ADr John Murdoch: Not at present, but it appears to be useful to triage mild or borderline smear abnormalities and as a sensitive test of cure.
 

Letter Qfridascruffs: I had laser treatment to get rid of abnormal cells when I was about 25; I am now 45, and have had clear smear tests since. But can the infection come back again, or would I have to be reinfected? Is there any point in being vaccinated as an adult? (I am single.)

Letter ADr Anne Szarewski: Both scenarios are possible. You might find a new partner and catch a new HPV infection. In fact, recent studies suggest that the over-45s are showing the greatest increase in all sexually transmitted infections. We do not know whether HPV infections can lie dormant for many years, but it is possible.

There is certainly benefit in being vaccinated as an adult, but what I cannot tell you is exactly how much protection you might get. You have probably had an HPV infection in the past, since you have had abnormal cells. However, studies are showing that even in such cases, it appears that the vaccine acts as a sort of 'booster'; it appears that natural immunity against HPV is not very effective, which is why the vaccine can still help.

Research in this area is ongoing and even since this review was published, studies are providing stronger evidence for vaccinating 'older' women. You might not be able to get the vaccine on the NHS, but you can certainly get it privately by going to Boots or Lloyds and get the vaccine there. 
 

Letter QGoldengreen: I have had two children via fertility treatment but have never had sex with a man. I had a clear smear test after my first child and plan to have another when it is next due. My question is, if that is clear, do I ever need bother again (no more kids planned, am faithful to female partner)? Or should I be tested for HPV instead? 

Letter ADr Kheng Chew: Although you may have been told that you do not need to attend cervical screening because you have not had sex with a man, your risk is not zero. HPV infection which causes cervical cancer can be transmitted through body fluids, which includes oral sex, transferring of vaginal fluids on hands and fingers, skin-to-skin contact in the genital area particularly if there has been a tear in the skin (often microscopic and not symptomatic or visible to naked eye) and sharing of sex toys.

I am not certain how your children were conceived but seminal fluid is not tested for HPV infection. Although you are faithful to your female partner, if your partner has had other relations with partners of either sex, she may be a carrier of the HPV. The NHSCSP (National Health Service Cervical Screening Programme) advises that you should continue with cervical screening. Further information is available at its website.

HPV infection is transient, which means it comes and goes, so a negative HPV test may give you a false sense of security. I would advocate continuing in the cervical screening programme.
 

Letter QSoloBlackWidowSpidersWebSite: It's always worried me when we are given a smear which comes back 'normal' and then three years later, we have the next. Surely if six months after a normal result smear test is given your cells begin to change, you are then in serious danger of developing cancer and even dying because of it. Why are smears done three years apart? Surely doing them every 12 months or even 18 months would save many more lives? 

Letter ADr Anne Szarewski: It takes at least 10 years for cervical cancer to develop after an infection with HPV. Cervical smears can miss abnormal cells, especially if the area is small, that is why you have smears at regular intervals. Since we know that it takes at least ten years for cancer to develop, the idea behind the screening programme is that you would have had at least three smears in that time and it is unlikely the abnormality would be missed by all of them.

Very few countries offer a free screening programme. In the majority of countries, women pay for their smears, or they pay for health insurance which covers the smears. A screening programme is very expensive, so it works on a 'greater good for the greater number' principle. In countries where women pay for smears, they can have them more frequently. The level of protection is higher, though not hugely greater, with two yearly rather than three-yearly smears. Annual screening has not been shown to give more protection than two-yearly screening.

 

Vaccination

Letter Qwhomovedmychocolate: If cervical cancer is caused by a sexually transmitted virus, why can't men be vaccinated instead of women? It seems wrong to make it women's responsibility, we already have childbirth and, in the majority of cases, contraception to worry about.

Letter ADr Anne Szarewski: We should certainly be vaccinating both boys and girls; as you say, it shouldn't just be the woman's responsibility. It's a question of money and value for money, I'm afraid. Women are the ones who get cervical cancer.

Personally, I think it is likely that in the future boys will be vaccinated as well, as the best overall protection with any vaccine is achieved by including as many people as possible. By doing that, the few who remain unvaccinated are still protected because everyone around them has been vaccinated.
 

Letter Qsarls: Why do girls have to have the HPV jab so young? Is it not a bit too young?
 

Letter ADr Anne Szarewski: It is true of most vaccines that you get the best immune response to them when you are young and the younger the better. That's why most vaccines are given to young children. It has been shown that young adolescents have a better immune response to the HPV vaccine than older women, and that may mean that the protection lasts longer. Another reason for giving it around the age of 12 is to try and vaccinate all girls before they start having sex – and in this country many girls are sexually active before they are 16, indeed even at 14.

 

Education

Letter QJoolyjoolyjoo: Is the risk associated with HPV taught to boys and girls in sex education classes nowadays? It certainly wasn't in my young day. We were taught that condoms would protect against STDs.

Letter ADr Anne Szarewski: I am not aware that information about HPV is given, but I imagine some information must be provided in regard to the HPV vaccination programme, though that is targeted at girls, rather than boys. Condoms do provide some protection against HPV, just not as well as they do against other STDs because HPV is present in the skin in the whole genital area, not just in the vagina/on the penis.
 

Letter QBelaLugosiISDED: Should there be an education campaign to increase public awareness of:

  • The difference is between screening and a diagnostic test?
  • The limitations of screening?
  • Successes of the NHS CSP and how that influences policy decisions such as age at first/last screening and screening intervals?
  • What to do if they have symptoms that could be associated with cervical cancer (i.e. what investigations they should be able to expect to happen)?
  • What abnormal results mean (especially borderline changes)?
  • What treatment they can have and who to talk about their treatment?
     

Letter AJCCT Team: Education is a big focus for us as a charity and in the past year we have launched a new website with even more information about HPV, cervical screening and vaccination, symptoms of cervical cancer and information about treatment and post treatment issues. Through our work we have recognised a greater need to provide more in-depth information to the public and in which areas we can have the biggest impact in terms of education.

We now provide factsheets to GP surgeries, colposcopy units, oncology wards and to the general public on a range of topics.

Awareness of symptoms and prevention is very important to us and we have run several targeted awareness campaigns including working with the music and fashion industry, a poster and postcard campaign in cinemas, and running advertisements in selected GP surgeries which saw an increase in screening attendance as a result.

As part of our new services launching in January 2011, we will have a national helpline to also help women and their families with queries including those about vaccination, screening and results.
There are also now two weeks in the year when we really increase the heat on awareness – Cervical Cancer Prevention Week in January and Cervical Screening Awareness Week in June. Two great opportunities to raise awareness of cervical cancer and how to prevent it. You can see what we get involved in here. 

 

Symptoms

Letter Qkentmumma: I have recently been experiencing some bleeding after intercourse and wondered if this should give me cause for concern. My last smear, two years ago, was normal as were the ones before that so that's a good sign, isn't it?

Letter ADr Simon Moore: There are many possible causes for bleeding after intercourse and most are not serious. However, there is no doubt you should go and see your GP who can take a full history and examine you. They will probably want to take a swab and also repeat your smear test even though your last one was two years ago. Certainly these symptoms should not be ignored.

 

Cervical abnormalities

Letter QMeganmog: I was found to have CIN2 cells several years ago shortly after two clear cervical smears (I was referred as I had abnormal bleeding). I had treatment, and I now have annual smears, but am concerned that as the smears didn't pick up the CIN2 before, that they may not again. The consultant did say that the virus type was a slow variety, which is something. Is just having regular smears sufficient?

Letter Qwendihouse: I'm 48. Ten years ago I had CIN2, which was only found on colonoscopy having had smears showing no abnormality or mild dyskariosis. I had laser to the cervix and then for two years or so, had more frequent smear tests. Then I joined the normal review which I believe is three years? I am sceptical of smear tests.

My question is, if I went for two years with nothing much showing, then leapt to CIN2 (and I read the bit about small lesions not always showing on smears) how do I know that all is genuinely OK? I've been having irregular bleeding and have a dull ache constantly on my left lower abdomen. My smear of six months ago was normal but, I've been there before. I don't trust them!

Letter ADr John Murdoch: Smears are not perfect and do miss precancer changes from time to time. It usually takes about 10 years before cancer develops so, as with you, having smears every three years will identify a problem before cancer develops. Having smears after treatment is important and will show up any problems in future. About one in 10 women who have treatment will have some form of smear problem in the next 10 years. The smear service worked perfectly for you.
 

Letter QTheOldestCat: I too worry a little about smear tests. I'd always got the all-clear at regular smear tests, but when I did get an abnormal result, the precancerous cells were fairly advanced (CIN3). My doctor said it would have taken several years to get to that stage, so why wasn't this picked up at an earlier smear? Or can changes occur more quickly?

I don't mean to sound ungrateful at all - in fact, I'm massively grateful that the changes were picked up, the abnormal cells removed and I've had the all-clear ever since. But is there anything else I can do, except have a smear every three years?

Letter AMr Mark Smith: Unfortunately, as effective as the screening programme is, it is still not a perfect test. There is the possibility that a fast-developing lesion can occur, but there is also the possibility that either the abnormal cells were not sampled in previous smears or that they were not detected during screening.

Even with all the quality control steps in place, sadly a few cases are missed. There isn't a single screening lab that doesn't have a few false negative smears due to the difficult nature of screening with the current test. So there are three possibilities here for a negative history followed by a high grade precancerous smear test.

As far as future precautions, definitely have the tests at the frequency suggested. Not to have smear tests is still considered the biggest risk for progression to precancerous changes, even though the test is not perfect. I hope this is helpful and makes sense.

Letter AJCCT Team: Cervical cancer is a largely preventable disease and you can do something to protect yourself: lead a healthy lifestyle – eat healthily, exercise, don't smoke, look after your immune system, attend screening when invited, know the symptoms and get vaccinated. 
 

Letter QMeglet: I had 2 LLETZ (Large Loop Excision of the Transformation Zone) treatments for CIN3 and a hysterectomy last summer. My most recent colposcopy was fine, last one due next spring. But what happens if the dodgy cells start creeping back again now my cervix has gone? Would I end up with vaginal cancer? I was going to ask my consultant next time I see him but would be interested to know sooner rather than later.

For what it's worth, I first had sex at 22, two partners, regular smears and CIN3 at age 30. In theory I was very low risk but am now on first name terms with the gynae team at the hospital.

Letter ADr John Murdoch: The current advice is that before a hysterectomy you should have colposcopy to ensure that none of the precancer changes were visible on the vagina. Assuming this was the case, you should ask your consultant if the histology report on the hysterectomy confirmed that the CIN was completely removed. If this is true and two vaginal smears at six and 18 months are clear then you are far less likely to get vaginal cancer than almost any other cancer as it is very rare.
 

Letter QPinguwings: I'm 21, and because of post-sex bleeding I went to the doctors. He said I have cervical erosion. He did a smear test as well. I have found out that cervical erosion can lead to cervical cancer. I originally dismissed this, thinking I'm too young. Anyway results from the doctor have come back inconclusive and they need me to do another smear test immediately. What does it mean? Did something go wrong with the test or do they need to double check?

Letter AMr Mark Smith: First, just to also explain the term 'erosion' in this context. It is purely descriptive ie the cervix looks eroded. It may not actually be eroded though. It is not specific to a particular condition, so can be anything from a normal transformation zone to an abnormality. The problem is that it can look worrying to the smear taker even if it's completely benign. 

Second, the term 'inconclusive' probably means the lab report called it 'borderline changes'.
One of the difficulties with screening smears is that there are a range of normal cell changes that can mimic abnormal changes. It's not always an easy case of 'normal' or 'abnormal', unfortunately. There are several grey areas. 

For example, inflammatory changes can be quite marked and it can be difficult for the screeners to determine if the changes represent abnormal ones or not. In this case it will be reported as borderline so that another smear can be recommended that may give a clearer diagnosis. Most borderline cases are clear by the time the second smear is taken. So to summarise, inconclusive just means cell changes are present that are difficult to interpret and they are playing safe. Hope this helps.

Letter AJCCT Team: There are now GP guidelines in place for women under screening age presenting with symptoms to ensure they get appropriate care. You can view these guidelines here. 

Letter QHoneyIatethekidsdragon: I had CIN3 nearly four years ago, and my smears have been clear since treatment. Is it only the HPV virus that causes this? If so, is it from my husband, and should he be tested in any way? And can I do anything to minimise my risks of it returning? I am only 31 and am scared they may put me back to three years or I'll forget a smear and something awful will happen. 

Letter ADr Kheng Chew: If you had treatment for CIN3 four years ago and your cytology tests have been negative since, your risk of this recurring goes down with each year. The current recommendation is for you to have annual cervical cytology tests for total of 10 years. You are right in thinking that HPV infection which causes these changes is transmitted through sexual activity. Re-infection can happen. Using condoms for contraception can reduce the risk. Cigarette smoking is another lifestyle behaviour which increases the risk of changes in the cells in the cervix.

Checking your husband for HPV infection, which incidentally is not currently available on the NHS, is not particularly helpful as at present there is no cure for HPV infection. Please do not worry about forgetting your cervical cytology test. If you miss your initial appointment, you will be sent another two reminders to encourage you to attend. Please ensure that if you move from your area, you stay registered with a GP practice that has your valid address and make sure that they are aware of your cervical screening history.
 

Letter Qblackcatonabroomstick: I had precancerous cells removed at 21 and have been having yearly smears since. I changed my doctor last year and they said I was on three yearly smears again now. Do you think this is right? I'm 37 now.

Letter ADr Anne Szarewski: Yes I would agree with your doctor. Now you have had normal smears for so long it is quite reasonable to return to a three yearly smear test. Of course, if you get any abnormal symptoms in the meantime, you should tell your doctor immediately.

 

Cervical cancer

Letter QMaryAnnSingleton: I'd like to ask how much of a risk there is of getting cervical cancer because I take Tamoxifen.

Letter ADr Kheng Chew: There is no known association between Tamoxifen and risk of developing cervical cancer. Tamoxifen, however, can sometimes cause the lining of the womb to grow, and occasionally develop into cancer, this is rare and the benefits of preventing recurrence of breast cancer outweighs the risk of womb cancer. The recommendation, however, is to let your doctor know if you have abnormal vaginal bleeding while taking Tamoxifen. 
 

Letter Qshantishanti: I always thought that if I had regular smears it would stop me getting cervical cancer, but it didn't, and I've been wondering ever since why. I had a clear smear, then my next routine one three years later picked up moderate changes, so I was referred for a colposcopy. By the time the appointment came round I realised I was pregnant so the consultant just monitored me throughout my pregnancy. He thought they were moderate changes, nothing to get too worried about. But it turned out when I went back for treatment after having my baby that I had cancer.

So my question is, can pregnancy speed up the growth of cervical cancer? Or is there any other reason why it might have happened so quickly? I was 30 at the time, non-smoker, in a relationship for 12 years, totally faithful.

Letter ADr Thomas Ind: The question concerning pregnancy is a difficult one to answer as it is unknown. There are a few review papers looking at cervical cancer in pregnancy and some suggest that these cancers might be worse, yet others do not. The answer to that question is that it is simply unknown. Having a smear test according to the national cervical cancer prevention programme will prevent 91% of all cervix cancers for those women who have participated. It doesn't eliminate cervical cancer but does reduce the risk.

With respect to your management, it does look like the correct management. A smear test on its own is only 50% accurate, which is why women have repeated tests, it is normal in this situation to have your smears reviewed and I would recommend this. I wish you all the best
 

Letter QCMOTdibbler: Don't you think the information about radiotherapy and Brachytherapy on your website should be up to date? Do you think that young women should be made aware of just how much smoking increases their risk of having cervical cancer?

Letter ADr Richard Edmondson: It is always difficult to provide information that is applicable to all women in all situations and there can be minor differences in the way that radiotherapy is delivered between centres, often to do with the exact type of machine that is being used. As far as we are aware however the pages that appear on the website reflect current practice across the UK. 

I agree completely that smoking is related to cervical cancer and most health awareness campaigns will mention that smoking is associated with a wide range of cancers, not just lung cancer. All women who attend colposcopy clinics will be asked about their smoking habits and advised accordingly. The link between lung cancer and smoking is so strong however that we know that this message often drowns out any message regarding smoking and other cancers.

Letter AJCCT Team: If you have a 'high-risk' HPV infection and smoke, you are twice as likely to have pre-cancerous cells in your cervical screening test, or to get cervical cancer. The Langerhans cells are less able to fight off the virus and protect the cervical cells from the genetic changes that can lead to cancer.

Remember, if you smoke you are more likely to get cervical cancer. If you have mild pre-cancerous changes in your cervical screening test, the cells are more likely to go back to normal without any treatment if you stop smoking.
 

Letter QStarbellysneetch: I'd like to know if there is any connection between breast cancer and cervical cancer. I have a history of breast cancer in my family (not strong enough to get more frequent screening). Does this put me at higher risk of cervical cancer?

Letter Qleatra: My family have a history of breast cancer, I'm the only female in my entire family (and there's lots of us!) who does not carry the gene. Should I worry about cervical cancer as I know there is a link. I have several very small fibroids and feel fine overall. 

Letter ADr Richard Edmondson: There is no established genetic link between cervical cancer and breast cancer. Although there are some genes which mean that women are more likely to develop breast and ovarian cancer, these women seem to have the same risk as anyone else of developing cervical cancer. Therefore, the advice to these women is the same as for everyone, that they should have smears every three years unless there has been an abnormality in the past.

Jo's Cervical Cancer Trust is the UK's only charity dedicated to women, their families and friends affected by cervical abnormalities and cervical cancer. They offer a range of services to inform and support women and are there 24 hours a day, making sure that women never feel alone at any stage of their journey. 

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Who's on the team of experts?

Dr Kheng Chew - consultant gynaecological oncologist, Northampton General Hospital
Mr Thomas Ind - consultant gynaecological surgeon and oncologist, Royal Marsden and St George's Hospital
Mr John Murdoch - consultant gynaecologist, St Michael's Hospital, Bristol
Dr Simon Moore - private GP based in London; medical interests: obstetrics and paediatrics
Mr Mark Smith - biomedical scientist grade 3 (BMS3), Lewisham Cytology Dept, University Hospital Lewisham
Dr Anne Szarewski - clinical consultant and honorary senior lecturer, Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, London
Mr Richard Edmondson - consultant and senior lecturer in gynaecological oncology, Queen Elizabeth's Hospital, Gateshead

Disclaimer: We have made every effort to ensure that the content of these answers is accurate and up to date, but we accept no liability in relation to typographical errors or third-party information. Please be aware that the responses from the Jo's Cervical Cancer Team and their specialists are not a substitute for professional medical care. If you have any concerns about your health or any treatment you are receiving you should discuss these with your doctor. Responses from Jo's Cervical Cancer are only accurate at the time of posting as medical knowledge and treatment can change over time.

Last updated: 29-Oct-2010 at 2:25 PM