Medical question about the smear test

[Banana770]

I had my smear this afternoon and the nurse explained to me that the testing system is currently changing from them looking at the cells initially to testing for the presence of HPV, and only looking at the cells if there is a positive test for HPV. She said that in something like 97% of cervical cancer cases HPV is present. But what about the other 3% of women developing cervical cancer that isn’t linked to HPV? How is that picked up?

I’ve had some random bleeding (which GP is investigating before anyone tells me to go and get it checked out!) so this concerns me slightly - I was wondering if anyone medical could explain to me about what happens with the 3% where it isn’t caused by HPV. The nurse I saw said something along the lines of ‘they’re unlucky’ which wasn’t quite the reassuring answer I was hoping for!!

Thank you in advance to any medical folk who can explain it to me

Also sorry if I totally butchered the explanation there, that was what I understood from what she was saying but I might be wrong!

The 3% would be picked up based on symptoms, which to be fair, is how a lot of cervical cancer is discovered anyway. It doesn’t just time itself perfectly for the smear and takes many years to develop.

But NICE doesn’t recommend things unless they benefit the most people for the cost. The reality is that so many women avoid smears that very likely way more than 3% are missed in the previous way of doing things. Women think they aren’t at risk, miss their smears, lots of cervical cancer missed until fairly late stage. I suspect (I work in sexual health but not in this area, so I’m just hazarding a guess) that testing HPV first not only saves money by prioritising higher risk screenings for the women who need it most, but also alerts women to the fact they have a high risk strain - even if they have a totally normal smear. So they actually keep showing up for future ones. Instead of missing 12% of cancers, now only 3% get missed, which is an obvious improvement. I have no idea if that’s actually been the rationale but it would make sense to me that it’s probably part of it.

I had my smear test yesterday and I was confused by this as well.

I actually had CIN 3 15 years ago and had loop diathermy done to remove the dodgy cells (which I saw for myself on a huge screen as they were doing it). Nurse basically said yesterday well if the HPV detection had been around then you wouldn't have been treated and it would have just raised a yearly recall? Which makes no sense to me...surely if there are pre-cancerous cells they need to removed and isn't that the whole point of the smear test?