To not know they did this at a smear test

[ILoveBray]

Came back from mine today, and they are now adding in HPV screening. Not sure when this was added, but I'm pretty sure I didn't have it 3 years ago.

Think this is such a good idea, as if you have HPV you have a higher chance of getting cervical cancer.

Not really an AIBU, more a reminder to book in for your screening if it's been more than 3 years

This post was edited by MNHQ at OP's request

Ye well I've typed out the letter stating that I won't be called for 3 years.

They may have repeated the smear in colposcopy which was HPV negative, therefore reverting to routine recall. Although our letters would explain this. I would be querying that otherwise. As it is, you're back in the system and being seen this week.
Hope all goes well.

No, I'm not back in the system.
I'm being referred for an ultrasound (day after tomorrow), nothing to do with smears etc.

My area only texts for hpv in the first instance. Only if that was to come back positive would your cells be looked at. Not sure how happy I am about that. Surely there is still a chance of cervical cancer even without hpv?

Mine told me, if it’s negative then see you in three years (unless any symptoms arise), if positive then they’d see me again in a year, if in a year it was positive again then further testing, otherwise wait another three years.

If you have never had a positive smear by 64, why should you not need another smear after 64? Surely you can still get the HPV virus after being 64?

So daisy (or any other medic). Do I have this right? Smear test is used to gather a sample. Sample is analysed for hpv. Negative samples are disposed of. Positive samples are visually inspected. Research suggests that the test for hpv is a more reliable predictor than the visual check.

So my question is, is a smear test the only way to test for hpv? I think I have heard about swabs and bloods? If there is a different way to test for hpv, could the screening not be 2 phase; hpv test then smear if needed? Unless the hpv test is as invasive as a normal smear, this might up attendance? Am I missing something here? What I would like to hear is that there is an alternative to smear tests that is less invasive and easier!

They did it at mine last year.

What I would like to hear is that there is an alternative to smear tests that is less invasive and easier!

Not yet but I’m sure there will be. Self test for hpv then call positives for further investigation in the same way poo pots are sent off for testing for blood to identify possible bowel cancer.

7Pip - your sample has been checked for pre-cancerous changes though. From the info you posted, you've then been to colposcopy, had a biopsy (tissue sample) taken which has no shown an abnormality. So they've investigated further, found nothing which is why you were given 3 year recall.

Forgot to say your summary is right.

HPV testing is very sensitive for picking up HPV. It is less specific for identifying pre-cancerous changes because only a proportion of women who test HPV+ have pre-cancerous changes.
This is why they're doing primary HPV, and making a slide to look at the cells if the initial test is HPV+
If you replace the initial screening with a blood test then you still need to have cervical cells to examine under the microscope.

What I would like to hear is that there is an alternative to smear tests that is less invasive and easier!

It makes no sense for everyone to have to go through all the unpleasantness of having cells removed from their cervix if no one is looking at most of them. They have HPV self testing in Netherlands, apparently.

loz
www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/a-study-looking-at-testing-for-hpv-using-vaginal-swab-and-urine-sample#undefined

There have been trials of self-administered tests where women’s collected vaginal and cervical samples as well as urine samples
None were completely effective

The urine test was the least reliable but the test is being developed. Perhaps that will be the future goal, but I imagine there will be a time limit to develop good tests, before the high prevalence of the vaccination means routine testing isn’t as necessary

The reason for the change (which is being brought in across England fro July 2019) is because of HPV vaccination.
It means (hooray) there will a lot fewer abnormalitie, because they've been prevented by the vaccine. That means for screening that the haystack to find the needles (the abnormal results) gets bigger and bigger. This makes screening (looking at the samples under the microscope) really hard.
Under primary Cytology, roughly 10% are abnormal.
As the vaccinated popn come through this will probably drop to 3% (estimate), making visual screening incredibly difficult.

As an analogy, imagine watching Crufts and being asked to point out all the pugs....quite a few in 10000 dogs but fairly easy to do.
Imagine you're then asked to pick out the 5 pugs wearing red collars in 10000 dogs. Quite hard!!

The vaccinated population are starting to attend for screening shortly (the catch up cohort).

People may also find it interesting that with the roll out of primary HPV, the laboratory testing is being centralised from 49 to 9 across England.
This means many experienced, highly trained screening staff will either have to relocate, travel long distances or find other work.
The HPV tender awards are due to be announced in April, which is when we will find out who the winning bidders are.
In some regions e.g, the North East, there are hundreds of miles between the current labs, so it's very likely that many staff will be out of work.
In the meantime, screening staff are trying to find other jobs, so this is why results are getting delayed because there are fewer staff.

7Pip it's dyskaryosis - it's Greek and literally means "bad nut". It is a term used to describe the changes in the nucleus of abnormal cells.

Yes but what about us over say, 35 who are too old to have been vaccinated. What happens to us.

Nothing has changed for us. Do we risk dying of CC because it's been eliminated in the generation below us.

You all know that this is a load of bollocks.
Testing someone 3 years after a high risk strain of HPV has been found is not satisfactory.
End of.

The government site regarding Primary HPV

Screening pathway
Colposcopy pathway

I don't trust the government honey.

Why have I been referred for an urgent ultrasound?

7Pip - have a look at the pathway/flowcharts so you can follow the route you've been through. The colposcopy investigation is the next step in assessing the risk. Under primary cytology + HPV testing you could have had the same outcome as a negative colpscopy assessment would also be a 3 year recall. That system has been running for 6 years.

LucilleBluth - the non-vaccinated population continue with screening as does everyone else.
If your sample test HPV+, a slide will be made, the cells assessed.
If no abnormal cells are seen then you get 2 repeats, if still HPV+/cyto neg on the 3rd then colposcopy referral (if on triage pathway).
If abnormal cells are seen then colposcopy referral.
Why does reducing the risk of cervical cancer in one group increase the risk in another?

Sorry purple daisies (and thanks for your reply) my wording was clumsy. What I should have said is not is there an alternative to smear tests but a way to reduce the possibility of needing a ‘full’ smear test. And it sounds like there is?

Tenbob - thanks for that link. I read it and the conclusion is:

The study team concluded that HPV testing using vaginal samples works as well as cervical smear testing at finding abnormal changes in the cervix. So they say that vaginal sampling should be considered as a primary screening tool for cervical cancer.

So the team dismiss urine tests but recommend the vaginal sampling. ‘The study team found that testing for HPV in vaginal samples collected by the women was as reliable at finding abnormal changes as the smear tests. That sounds like the ‘smear’ test as the first point of contact is unnecessary?

I have a strong interest in this as I am currently unable to have a smear test so if I could have a swab ( no speculum required presumably as self administered) that may (assuming negative hpv) be sufficient?

This is the recent paper in the BMJ from the primary HPV pilot sites with the data

7Pip - I can't answer why you've been referred for a U/S you need to talk to your GP.

Whether you trust the government or not, that's what they've decided. If you don't like it, can I suggest you write to your MP.