Smear test question

[Retrain12345]

I’ve just had another smear test yesterday however reading online it now states they test for HPV and if it’s clear they don’t check the cells. So does this mean if your HPV clear you cannot have any chance of cancer?

I have had trouble with cervical ectropion for a while and my GP is very dismissive- they tell me if the smear is clear then I’m fine but I’m really worried that the problems I have are related to cancer and now it won’t be picked up by the smear if they don’t look at the cells. I’ve got a few symptoms that worry me but the GP has declared it benign by looking at it. My aunt died of cervical cancer in her 30s so it’s something that plays on my mind, maybe I'm paranoid.
Do I just trust what the GP says or push this further? If so to where?

Thanks!

Push further. See another GP - is there one available at your surgery?

The vast majority of cervical cancers are caused by HPV. However there is such thing as HPV negative cancer (although it is fairly rare). I really do think that they should still test the cell samples for both HPV and abnormal cells but I guess it’s more cost effective not to sadly… if you are having abnormal symptoms I think you should push for a referral to a gynae

I think the chances of cervical cancer if you are HPV negative are something like 0.2%?

I was worried about this previously as I have a history of abnormal cells. The last nurse I spoke to put it in a much better way. She basically said that it's only the cell changes with HPV that you need to worry about as these are the ones that turn cancerous. Abnormal cell changes without HPV are irrelevant. I am HPV negative but had severe abnormal cell changes which required treatments. She said that if I was diagnosed now, I wouldn't have had to have the procedures as the cells wouldn't have turned cancerous without HPV. It is this procedure across the board though so I wouldn't have thought going to a different would help unless you went private.

I hope she's right but that's what she said.

She’s not right. You can have cervical cancer without HPV. It is less common but it is possible. That’s why it’s so important to push for a gynaecologist referral/colposcopy if you are having symptoms even if HPV negative.

See eg: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925842/#:~:text=Approximately%205.5–11%25%20of%20all,negative%20and%20false%2Dnegative%20results.
“Approximately 5.5–11% of all cervical cancers are reported to be HPV-negative, which can be attributed to truly negative and false-negative results”

the question no one has answered for me. Is whilst in the vast majority of women HPV causes cancer first what research has been done to see whether some people would still go on to get cancer? And therefore are we just being currently treated as a large data collection excerise.

The research was done prior to them introducing the HPV vaccine - hence the introduction of it

Cervical ectropion (used to be called erosion) doesn't cause cancer. Back in the day they thought it did, but it's fine.

@GoodChat was it? It was specifically researched that the only cause of cervical cancer was HPV?

Out of curiosity, do you know how they went about it?

Thank you everyone. I think I’ll go back again.

Im not worried that the entropion will cause cancer, more that it is cancer that’s been misdiagnosed and I’m relying on one mans opinion from looking at it through a speculum. Can it look similar?

Ive asked twice for referral but been refused.

That wasn't the question you asked. There can be other causes of cervical cancer but HPV is the most common cause. Around 90% of cervical cancers are caused by HPV.

It is the question I asked (worded poorly) I’ll try again:

90% of cervical cancers are currently caused by HPV. For that cohort of people how many would still go on to develop cancer (even if they didn’t have HPV).

In if you jump off a skyscraper with a broken parachute you’ll die. If you a struck by lightening before you jump you are still dead and your cause of death is lightening (not broken parachute).

So one might argue that if we just remove lightening everyone is fine, but the parachute is still broken and if you jump you are still dead.

is HPV the broken parachute or the lightening?

Here is some helpful information that explains a bit about the rationale behind HPV screening as the first step in cervical cancer screening.

To answer your question, yes, there is a very small percentage of cervical cancers that are not caused by HPV.

But ultimately, there is more risk that cervical cancer will be missed when looking just for abnormal cells than when looking for HPV. Because you can be HPV+ but have perfectly normal looking cervical cells...that become cancerous very shortly after. But if your smear was 'negative' you wouldn't be called back for regular screening and the cancer would be more likely to be more advanced by the time it was detected.

So HPV screening aims to identify those who need more regular monitoring for cervical smears, so that cancer can be caught as soon as possible.

So yes, some HPV-negative cancers will be missed, but this is balanced out by identifying more cancers as a whole at an earlier stage.

https://www.jostrust.org.uk/information/hpv/hpv-testing

Sorry I must have misunderstood the first time around. This is long but interesting:

www.cancer.gov/news-events/cancer-currents-blog/2020/hpv-vaccine-prevents-cervical-cancer-sweden-study#:~:text=More%20than%2080%25%20of%20those,538%20of%20the%20unvaccinated%20women.

Its a 63% reduced risk of getting cervical cancer if you have been vaccinated, and the younger you are vaccinated the better your protection, so 90% reduced risk if you're vaccinated pre-teens.

I’d ask to see a different GP; I doubt very much a GP can make a diagnosis that everything is fine. It needs a specialist; I saw a gynaecologist for a cervical ectropian and the treatment that was required

Hpv can come and go so I struggled to understand the same thing (also have an ectropion and bleed after sex and between periods etc)

it does seem like people will slip through the net if they only test for hpv

also to add my mum had cervical cancer at 27 so I’m extra cautious.

id push to see a gynecologist…

I'm concerned about this too. I've previously had abnormal cells that required a LLETZ procedure. Was told by my gp that they only test for hpv now and I asked her to look at my notes and she said last time I had abnormal cells I was hpv negative but that even though some women get cancerous cells without hpv it's rare. I think she said hpv can also come and go?
Very confusing, surly they still need to look for cell changes? I know two women who died from cervical cancer one was under 25. I was planning to look into going private, can't really afford to but I don't feel safe with how they test at all. Unless my gp has explained it wrong?

Also if I've understood correctly and HPV can come and go and the likelihood is if you've had sex you have hpv (gynaecologist told me this years ago.)
Will having the HPV vaccine now (41 years old) privately prevent cervical cancer or is it to late?

Does anyone know if you can be hpv neg and the hpv pos 3 years later? (If you have not had any serial contact in those 10 years)?

Yes it’s possible.