What you need to know about cervical cancer
Every year in the UK, over 3,000 women will be diagnosed with cervical cancer – it is the most common cancer in women under 35. Claire Cohen of Jo's Cervical Cancer Trust and Adeola Olaitan of University College London Hospital answer your questions about screening tests and the symptoms to look out for.
How often should I be screened for cervical cancer?
Claire Cohen: Across the UK women are first invited for cervical screening (a smear test) at 25. From the ages of 25 to 49 they are invited every three years, and from the ages of 50 to 64 women are invited every five years.
What if I'm scared of having a smear test? Is there an alternative?
Claire Cohen: Talk to your practice nurse in advance of your smear test appointment – they can show you all the equipment involved in the test, and talk you through the process. They can also use additional lubricant and a smaller speculum so it's less uncomfortable. If you are post-menopausal, applying oestrogen cream to your vagina for a few weeks before the test will make it more elastic and less likely to bleed.
Urine testing is very much in the research testing phase, and not currently offered as part of the NHS cervical screening programme. Hopefully in the future other methods of screening for HPV will be available, and make it easier for women who've had any kind of vaginal trauma to get tested.
How accurate is cervical screening?
Claire Cohen: Cervical screening is 80-90% reliable. A screening takes a sample of cells from the surface of the cervix. Since it's only a sample, a screening does not always accurately reflect what's occurring in the whole layer of the skin, which is important to make a diagnosis and find abnormalities.
What happens if a smear test comes back as abnormal?
Claire Cohen: The smear test looks for abnormal cells that have been caused by high-risk HPV which causes the majority of cervical cancers. If your smear test showed abnormal cell changes but no active HPV, then you are at a low risk of developing cervical cancer, and those changes will probably go back to normal on their own.
Adeola Olaitan: A smear is a screening test – it doesn't say this is what is wrong with the cervix, but what might be wrong. That is why women with abnormal smears are then referred for a colposcopy & biopsy which guides treatment.
What if I decide to opt out of having a smear test? Are there any implications?
Adeola Olaitan: Attending cervical screening is absolutely a choice, and if a woman makes a decision about not attending then this should be respected. However, it is vital that all women are able to truly make an informed choice about attending. For this to happen it is essential they have all of the information to be able to make that decision, and it must be presented in a way that they fully understand. Our research has shown that for significant numbers of women there is a low understanding of what cervical screening is for, and the role it can play in preventing cervical cancer.
For example over two-thirds of women aged 25-29, and 20% of women over 50, do not think cervical screening reduces a woman’s risk of cervical cancer – therefore we are concerned that women who are choosing to opt out or delay screening may not be fully informed about the health risks of not attending. Cervical screening prevents 75% of cervical cancers and saves an estimated 5,000 lives every year in the UK – not attending is the biggest risk factor to developing the disease. Since the screening programme was introduced we have seen significant drops in both incidence and mortality and as a charity that believes cervical cancer could one day be eradicated, we would encourage women to attend this potentially life-saving test when invited.
What are the symptoms of cervical cancer?
Claire Cohen: The symptoms of cervical cancer to look out for are any kind of abnormal vaginal bleeding in between periods, during or after sex, unusual discharge, pain during sex, and lower back pain. If you're experiencing any of these contact your healthcare professional to discuss them. It’s important to note that not all cervical cancers have symptoms, and there's a great video on Jo’s Cervical Cancer Trust website about symptoms.
Is cervical cancer hereditary?
Adeola Olaitan: Cervical cancer is caused by a virus called HPV. It is not hereditary so having or not having a family history of cervical cancer does not have an effect on your risk. There is no link to cervical cancer if you've had breast cancer or have the BRCA gene.
What can you do to reduce your chances of getting cervical cancer?
Claire Cohen: Stopping smoking is one of the biggest lifestyle changes you can make to reduce your risk of getting cervical cancer. Smoking affects the cells of the cervix and makes it much harder to clear HPV, the virus that causes cervical cancer. If you're having sex, using a condom can also help to reduce your risk of getting high-risk HPV. You can find more details on the Jo’s Cervical Cancer Trust website.
What is an HPV test?
Claire Cohen: At the moment, some parts of the UK are trialling primary HPV testing using self-sampling kits, and this may in the future be available as part of the national screening programme. The HPV self-test is certainly a better option than no screening at all . If you are HPV negative then the risk of cervical abnormalities is insignificant. If you are HPV positive you will require further testing. However a private HPV test is not linked to the national programme, so if HPV were found, it would be difficult to bring those results into your GP's surgery.
What is the HPV Vaccine?
Claire Cohen: The HPV vaccine helps to prevent 70% of all cervical cancers. By 2025, the number of women under thirty diagnosed with cervical cancer will go down by two thirds. This means, in the future, we'll see less women diagnosed with cervical cancer as a result of the vaccine. The HPV vaccine is offered to girls under the age of 18 – this is because it is most effective to vaccinate someone before they have come into contact with high-risk HPV. Girls who've had the vaccine will still need to attend cervical screening when invited in the future. The efficacy of the vaccine is so good that it provides long-term protection against high-risk HPV. Although the vaccine could benefit women of all ages, at the moment the Department of Health only funds vaccination for women under 18. You can pay for the vaccine privately via a private GP, or at some high street pharmacies.
Where can I find out more information?
Jo’s Cervical Cancer Trust is the only UK charity dedicated to women affected by cervical cancer and cervical abnormalities.
Mybodybackproject.com is an organisation that supports women who've been through sexual assault, and they offer special clinics that women can attend to have their smear tests done.
Adeola Olaitan is Consultant Gynaecological Oncologist at the University College London Hospital.
Claire Cohen is Head of Information and Education at Jo’s Cervical Cancer Trust.