Smear tests are they worth it nowadays?

[Sheepsheepie]

Had my smear test at the start of the week and they only look for HPV now days which is passed on through sexual contact. Limited data suggests it can be passed on non sexual.

If your in a relationship and faithful then is there much point to smear tests now?

Only positive is the nurse can see your cervix and flag and visual issues?

Not trying to put anyone off smear tests and if you’re with multiple partners there is still a benefit (or have an unfaithful partner).

Is it putting people off going for testing?

So given the statistic of how many women are HPV+ (at some point in their lives), either the people on here are a statistical anomaly that they don’t need a further smear via the NHS (which won’t accept a private/Superdrug result without redoing the smear) or the sample being collected isn’t correct.

I have been with the same man for 10 years. Every smear test until this year was clear and this one showed HPV with the highest grade of cell change. I've had to have treatment to burn off part of my cervix. If I hadn't had a smear, who knows what might have happened.

Yes ofcourse they are worth it.

1. They still look at your cervix and they might notice benign growths/polyps/colour changes etc.
2. HPV can reactivate - which it did in my case after having a negative result.
3. You can never be 100% certain your partner isn't cheating, or won't in the future.

I've only ever had one smear test when I was about 20.

I was booked in for another when my son was a few months old and missed it because my son was rushed into A&E and was hosptialised for a week. When I called afterwards to explain and rebook they were so bloody rude to me that it put me off.

The local hospital, which proceses the tests, was then in the news several times for mixing up test results resulting in patients receiving incorrect results and losing tests, which made the whole thing feel pointless.

Then I looked into the stats and it didn't seem worth it anyway.

I'm 48 now.

My point is that the NHS is putting women through having smears and only bothering to test them properly if they have HPV. What is the point? I can completely understand why women will buy the home tests as why go through the pain/discomfort if the NHS is only going to bin the sample?

I don't know.

I always wonder why they never extended vaccination to adult women, nor properly trialled it to see if it can work. I have even seen assertions from people working in the field that vaccination can prime the immune system to recognise HPV that has infected cells and is hiding from the immune system. Yet where are the studies?

Now there is a cohort who is vaccinated and a cohort who is not vaccinated and all are called up for 3 yearly testing.

The cervical cancer recall system has provided world class data for study as an incredibly large proportion of women have complied over the years.

Interestingly, HPV vaccination is assumed to work for men up to age 45 (the age the vaccine has been tested to) whether they are exposed to HPV prior to this, or not.

Sometimes I do wonder about the priorities of the cervical screening system.

Because it’s not that painful for everyone.
Because not everyone can afford a private test.
Because a significant % of women are expected to have HPV at some point in their lives and so many samples aren’t ‘just binned’.
Because if you do an OTC test that’s positive for HPV, you will need an NHS sample anyway.

Are you being purposely obtuse? I am not saying the current system is perfect for some women, both discomfort and how it’s tested, but the way MN repeatedly purports that NHS smear tests aren’t worth it is dangerous advice.

I pay for an at home HPV test instead now, as it's basically the same thing.

I have had a regular (normal) smear before I switched to at-home, so any abnormal cells would have been discovered. Checking for HPV only after having a normal result is good enough for me.

This. Same thing happened to me.

They are not akin to an STI check.

You're the one who's being obtuse. I'm not sure how I can be any clearer 🙄.

I know it's not painful for everyone but, reading previous threads on here, there are many women who do find it painful for various reasons. Why are they being put through a 'full' smear test when the NHS will discard it if they are negative for HPV? Why not offer the HPV test followed by a 'full' smear if it's positive?

I know not everyone can afford a private test. I can't really. Last year it was done privately as I was having tests for pelvic pain and it was only then I realised it didn't have to be as painful as it was previously.

No one is saying smear tests aren't worth it FFS, of course they are, but what I'm saying is there is a place for OTC HPV tests for those women who wouldn't be tested at all. If the NHS isn't going to improve their treatment of women then surely it's better than a woman uses the OTC test than nothing.

The stats are high for having it at some point in your life, but presumably most samples are negative for active HPV otherwise they'd still be doing the cytology on most of them as well.

I think they're pretty happy that self-done HPV swabs are accurate, some countries like Australia use that as the default for their national screening.

You're right that if a private HPV test comes back positive that the NHS will then have to do a smear, but it's not redoing it, the private test is not a smear and doesn't claim to be.

In countries which have been using HPV testing first for a longer period it shows that if 1,000 people are screened, about 20 people will have abnormal (pre-cancerous) cervical cells. The studies go on to show:

In screening with a cytology smear test (aka the old pap smear), 15 of these 20 people will have these cells found – five people will not, and may go on to develop cervical cancer. This makes the old cervical smear test 75% accurate.

In screening with a HPV-first test, 18 of these 20 people will have these cells found – two people will not, and may go on to develop cervical cancer. This makes the new cervical smear test between 85-90% accurate.

“Primary HPV testing is a much better test,” Dr Russell said. ”With cytology, or smear tests, there’s a one in 200 false negative rate. So one in 200 women are given the normal results, and actually the abnormality is there but not detected. Whereas with HPV testing, that goes down to one in 500. So it’s a much better test.”

“So you’re very likely to be in the 980 women who get the negative result. And you’re very unlikely to be one of the two women in that 20 who get a negative result [when there is an abnormality].”

Why is CervicalCheck using HPV tests instead of testing for all smear abnormalities? (thejournal.ie)

same and this has reminded me I bought a test and it’s been sitting in my knicker drawer for about 5 months! Must do it tomorrow !

Smears were fine for me - but now I’m menopausal they are no longer even remotely tolerable

Those who've gone private - where did you get that done? Just a private GP? I tried googling but couldn't find any info.

Ovestin is your friend here.

This really worries me to be honest having had CIN 3 in the past and high grade cells removed. The nurse doing my original smear told me my cervix looked perfectly normal, and it wasn’t - so to me the test is still very much needed. Does anyone know if a private smear still tests for the abnormal cells?

I don’t understand the whole “but HPV can lie dormant” argument tbh.

If you had tested negative for HPV in the past you would still need to have a smear test at the ‘right’ time later to get a positive result. Of course it is impossible to know when the right time is.

And you don’t need a smear test to be checked for HPV — there are other ways. So even if HPV was to lay dormant you can just do regular tests with a Superdrug home kit instead.

The only advantage I can see to a smear test over a home test is the nurse can visually check your cervix but they can only do that if they can actually get the speculum in to see your cervix in the first place. They are frequently unable to get it in with me and often has to be abandoned after multiple attempts.

I don’t think I would go down the Superdrug route as I don’t have massive issues with smear tests. Seems HPV can be dormant for years or it’s been passed on non sexually.

i will probably will attend them but I will look into private costs too. Which worries me as it’s becoming a who can afford private healthcare and who can’t society

From what I read the old tests gave a high chance of a false positive (30%) which meant a lot of women were unnecessarily worried and put through more invasive procedures that weren't actually needed.

If you read up on breast screening there's a similar issue.
https://www.cochrane.dk/news/new-study-finds-breast-cancer-screening-leads-substantial-overdiagnosis

Yeah I’d find that off-putting if that were sprung on me. My BMI is normal but I had anorexia and would be very thrown by suddenly being weighed and measured in a situation that I wasn’t expecting, and would be wary about the next time. I know that having up to date records is often part of the measures by which practices are judged, and many women would be fine with it as a quick check-up, but if you are trying to encourage people to have the smear test itself then it could well be counter productive.

@Sheepsheepie what is leading you to think that a private smear is desirable or preferable? I'm not being snarky , it's just that it's not what I have picked up from this thread and am interested.

Im happy to do the less invasive (so not painful) test for HPV first and if that is positive then I will go for a smear.

As fir why the NHS does the smear but then just does the HPV test is probably because
A) getting people to do 2 tests will reduce uptake
B) the NHS is very slow to change
C) perception that the full test is better
D) gp surgeries get funded on the amount of tests they perform

I too feel it isn't worth it anymore. Although I did have my last one done. I find them incredibly painful. Hate them. And to find out they'd stopped years ago testing in the way they used to, makes me very cross. NHS cost cutting at its very worst. How did they get away with this, changing it? Makes me cross.

@yikesanotherbooboo no offence taken 😊

I have mild health anxiety and the chance that the nhs test doesn’t always pick up abnormal cells (even if the chance is small) makes me think it’s it’s worth occasionally having a HPV and abnormal cells review on top of the nhs HPV test. I would rather go through a false positive than a chance something was missed.