To think in this situation a smear test is a waste of time?

[coffeeforone]

My nurse mentioned recently that smear tests only test for HPV, if you don't test positive for HPV then they won't look closely for pre-cancerous cell changes. Given this info I started wondering. DH and I were both virgins when we met. Assuming we both remain faithful, is it true that we can never contract HPV and so there is no point in the test?

Of course I will never stop being tested regularly (as I can never be 100% sure DH will always be faithful) but it did get me thinking, is this the only risk here?

I recently had a smear test, and it came up positive for HPV but negative for any changes to the cervical cells. I have to go back for a another smear in a year's time. No need for a colposcopy at this stage, they said.

People are not reading or understanding the op!

I had cell changes and laser treatment 30;years ago when I was 25. Thankfully been fine ever since. But a doctor later suggested to me that because I was young, the changes might not have been the sort that lead to cancer and the laser might have been totally unnecessary and this sort of false positive is why only older women are tested now.

Has what this doctor said become outmoded then, are we testing young women again?

Take the tests that are available. I'm sure the doctors would love to have a checklist of what causes cancers but they don't they can only say more likely to develop. Smear test or mammograms, go for it, at best they'll say 'see you next time' but could be 'see your doctor' in which case you'll be glad you went.

Sadly screening for men is less developed, the only routine test I've heard of is colon cancer tests.

@TinklyLittleLaugh plenty of young people are diagnosed with cervical cancer.

The earlier it's detected the higher the chances of survival - so why on earth would you not test? A smear test that doesn't find anything wrong isn't harmful in anyway.

That's not true. Screening programmes have known harms and should weigh up the risks and benefits. Cost being one.

Isn't it cheaper to have a smear test than to pay for treating full-blown cancer?

I think Melioration might have a point — I had the HPV vaccine and my first two screenings (I was at university in Scotland and they definitely start before 25) were before I'd done more than kiss anybody I was a late starter. The nurse did tell me the screening would probably be easier if I had sex before I came back the next time!

Now, the only person I've slept with was also vaccinated (GP parents who paid for him to have it done privately), so I do feel that maybe there are other people more at risk than I am. I'll still keep going though!

It depends on how many women you test with a smear to save one from cervical cancer. If it is thousands, then a cheaper test is needed. Also, how many colposcopies you need to perform to save one woman.

"adaline

Isn't it cheaper to have a smear test than to pay for treating full-blown cancer?"
OF course. That's not how it works though.

you are beyond unreasonable to post a message like this which might prevent other women from going for a smear

Which isn't what she did. She was asking a question or does she need your permission to ask a question?

In my area also the test has changed - they only check for HPV and don't check the cervical cells unless the HPV result is positive. Women whose cervical cancer is not related to HPV will be missed under this system.

I assumed its cost cutting as you still have to go for the smear (if you can get one).

The article I read states that the main problem is the anxiety that people go through when they get an abnormal result - as in most cases abnormal cells don't result in a diagnosis of cancer.

However isn't it better to have a thousand women treated for changes to cells if it means one of those gets an early diagnosis that saves their life?

If cost is an issue then they need to work out how to make it cheaper. The answer isn't to cut down on smear tests and increase the lower age for them!

It isn’t cost cutting although it will save money. It is because testing for hpv first is much more effective than cytology on its own. It is caught at an earlier stage so there will be less damaging treatment. It is a very good thing on a population level.

Cost is an issue for every bit of healthcare and preventative healthcare provided. There are drugs that can't be offered, treatment that can't be given. Everything is measured in terms of years of life saved and quality of life. There is no better way to do it imo, alongside delivering more efficiently as you suggest.

It is because testing for hpv first is much more effective than cytology on its own

That isn't the new procedure though is it? In my area if the HPV part comes back negative the checking of cells is not done. It isn't an augmentation of the existing testing, its limiting scope to people with a positive HPV test.

It will be cheaper in the long run. There have been massive changes going on in the background. The labs have been totally reorganised as they need fewer cytologists and more microbiology. The technology that supports it has all changed. It has been a big investment because it will be a more effective method.

Most of the answers here are irrelevant because they don't take into account the new way of testing being rolled out, which is to look FIRST for HPV and ONLY IF POSITIVE do they then screen the cells for changes. So if you had precancerous changes not caused by HPV then they wouldn't be picked up by the new test! Which is rather unfortunate for those individuals (to say the least), but at a population level, which is what screening is about, I guess it makes sense.

My reading is that this new testing method does indeed mean that in your position (I'm in a similar one) there's no point in now going for further tests.

Increasing the lower age for screening wasn’t to save costs - it was to prevent unnecessary treatment of changes in under-25s which they discovered would likely reverse naturally.

In my generation (ancient) we were screened from 20 with much lasering of youthful CIN1 as a result. This caused scarring of the cervix and in turn some pregnancy problems (incompetent cervix). Sounded like a fair price to pay at the time for “not getting cancer” until research showed that those CIN1 changes would probably have reversed naturally, if left in peace.

Not getting smears doesn’t prevent under-25s getting investigated if they have symptoms; they should be referred for colposcopy, skipping the mass-screening stage which is what the smear is.

The next big development is likely to be a switch to urine-based HPV testing, but that doesn’t address the OP’s issue which is how to deal with the residual non-HPV risk. I suppose the answer to that is: if you have symptoms, get seen, even if you have had clear screening results.

What do they do then if you've already been diagnosed with HPV? Do they call you in for a normal smear an retest for hpv or do they actually look at records and call you in for a proper smear? Because otherwise this could still be wasteful.

It has changed though. In the UK you have to be 25 now to be tested. 35 years ago I first got tested when I was 18 at uni. Having a smear was a condition of getting the pill. And we had to have one every year.

Cross posted with Lark, that’s basically what I was saying upthread but you said it much better.

Testing for hpv was only used to decide whether to take low grade changes to colposcopy and this was much better than the previous system. Testing for hpv first means that even if changes are not picked up in cytology then they can redo the test yearly until hpv or low grade changes are gone and only do the colposcopy if needed. In time there will be less higher grade changes and less damaging surgery.

@LauraAshleyDuvetCover they did start at 20 in Scotland until a few years ago. I was one of the last to get screened at 20 because the rules changed a couple of months later. It's 25 now.

I got my last smear in February and they were still testing for cell changes here - but I know the new system is rolling out elsewhere.

Agree with this. I had the HPV vaccination and DH and I have been together from first fumble onwards, so I do wonder if there is any point me going for testing under the new regime.

Yanbu. Even if your partner had HPV when you first got together, if you've been together a long time he'd have passed it onto you years ago. HPV usually self cures so if you've had a couple of negative smears you would be unlikely to still have it.
My area also just tests for hpv now, so even though there are occasional hpv unrelated cervical cancer cases, this test wouldn't pick those up, so there's no point having this test if you are not at risk of having hpv.
They will keep telling people to have the test because there's always a slight risk of infidelity at population level - but you know in your own relationship whether that's likely or not