Advice needed- smear test

[WhaleOfATale]

Recently had smear test and was told, as I am HPV negative, the cells would not be checked for changes.

I have irregular periods, bleeding between periods and a family history of abnormal cells found at smear tests (mother, sisters and maternal aunts- luckily these were caught at smears and treated before becoming cancerous but two family members had to have a few different treatments before being given the all clear).

I have spoken to the nurse that does the smear tests at my local GP practice and she said "it's stupid, we all think it's stupid that the cells aren't checked but there's nothing we can do to change it".

Does anyone know how I can get a full smear test to check for abnormal cells?

What did the GP/practice nurse suggest?

They said there was no way for them to do it, and they thought it was stupid. No further info. There must be a way though, surely? Even if I have to pay privately?

I would have thought that with bleeding in between periods and the family history etc that they would get you checked properly.
This worries me too as I’ve had treatment for
Abnormal cells before but now my cells don’t get checked.
Can you pay privately for a proper test?

That's NHS policy now for cervical screening. It's based on population level risks not individual risks.

Perhaps you could ask for referral to gynaecology to assess your individual risk and whether you would benefit from colposcopy?

Also, on re-reading your op, none of your family members have actually had cancer. Abnormal cells doesn't mean cancer, it means "changes that may or may not later become cancerous" .

So you don't have a family history of cancer or anything from which to receive the "all clear" . Cervical screening isn't a test for cancer, removing abnormal cells isn't a treatment for cancer. Most abnormal cells don't become cancer.

There is full details on how the cervical screening programme currently works here:

www.nhs.uk/conditions/cervical-screening/

I think it would be worth speaking to your GP to understand your actual risk level rather than panicking or potentially spending money on unnecessary interventions.

No, they have not had cancer but, as I said in my op, multiple members have had abnormal cells and had to have treatment to prevent this becoming cancerous. Two members had to have several treatments and all had to have annual smear tests until they'd had 3 negative results in order to go back to the 3 yearly tests.

There is a history of breast cancer, again maternal side, but I don't know if this is a cancer associated with cervical?

I've had a quick Google for private testing but it seems to be the same as NHS and, if there is a HPV negative result, no further action is taken.

Prior to my smear test, I wasn't worried as I'd read that only 0.3% of cervical cancer is HPV negative (and at that point I wasn't sure what my HPV status is as I'm sure this wasn't mentioned when I had my last test done?). However, when I spoke to the nurse, she said that my risk is still "significant" due to family history and she was sorry she couldn't do anything more- now.ive had my letter back confirming HPV negative and I keep thinking about her comment.

What is the point of doing a smear if no check for abnormal cells is done?.

My Practice nurse also said the same thing. They are not happy.

Hi OP
Cervical screening is for women without symptoms.
Other more appropriate investigations are available for women with symptoms. There are guidelines for the investigation of vaginal bleeding which the practice should be aware of and follow. There are a range of conditions that can cause VB /imb /PCB and cytology (looking at the cervical cells) is not a relevant test for them.
If you search for vaginal bleeding pathway and your area then you'll find what your practice should be following. Investigation usually includes a speculum visual inspection of the cervix. If they haven't done these investigations then I suggest you go back to them and ask for them to be done.
Also ask the nurse for references on the evidence that your risk is 'significant' due to family history. Which studies are there and how is the nurse quantifying the risk? The NHS CSP guidelines currently consider that family history of cervical cancer does not have a risk warranting additional or different screening.

Can I suggest that posters review the link that tornadosequins gave and also the gov screening website which goes through the evidence base for not making cytology on high risk HPV not detected samples.

Stress the bleeding between periods.
This should warrant a colposcopy exam.
Any issues they see a biopsy will be taken.
If everything looks absolutely fine you will be told all's well and you can put your worries to bed.

I questioned this when I went for my last smear. I said what about the cervical cancers that aren't caused by hpv and the nurse kind of shrugged.

Your practice nurse was very unprofessional.

So what happens if you have previously had abmomal smears? I had multiple areas of high grade abnormality which had to be removed with lletz procedure but I was hpv negative.

As previous posters have said please ask GP for referral on this.

This charity also has lots of helpful information and a support service on the topic.

www.jostrust.org.uk

@Spied colposcopy is for examining the cervix.
Vaginal bleeding can originate from various parts of the female genital tract, so is not necessarily an appropriate investigation.
Asking for a specific investigation can distract from thoroughly considering what the potential cause of the problem is. As I posted earlier, there are Royal College Obs & Gynae and NHS pathways to investigate this. The practice should be doing this; finding out your local commissioners pathway so you can go back to the practice staff to ensure the relevant investigations are carried out would be appropriate.

Agree @BelaLug0si.
It does seem though that colposcopy is the first port of call for unexplained bleeding between periods and post-coital bleeding. Certainly was for myself and for a couple of family members who also had problems.
It was later that uterine ultrasound and biopsy were discussed.

Cervical cancer isn't hereditary.
Did she note anything on cervical exam. Ectropian? Did she do swabs to exclude infection?
You need a vaginal/pelvic exam with a GP and a referral to gynae.
Practice nurse.