To think they should test every smear for abnormal cells even if you are HPV negative?

[Notmoreraining]

Just had the results of my smear and it says that I have tested negative for HPV so therefore they won’t be testing for abnormal cervical cells even if I’ve had them before because the risk is low. I am appalled. I went through a smear test for them not to to even bother testing for abnormal cells, wtf? Even if the risk is low I want them tested. Just read 70% of abnormal cells/cervical cancer are in people testing positive for HPV so what if I’m in that 30%? Are the NHS now routinely only testing for abnormal cells where there is HPV and is there going to be a big rise in cervical cancer as a result - or is the 30% that will now be missed too small a number of new cancer cases to even register? Don’t think this change - if it is nationally across the country - has even been publicised widely. Does anyone know about it or when it was brought in? Thanks

Not sure where you get 70% from - 99.7% of high grade CIN is linked to HR-HPV.

It’s 99.7% of cervical cancer, not 70%.
Also to perform a smear there is a physical examination of cervix.
Smear programmes are not intended for cancer detection but cancer prevention.

I'm a bit worried about this as well. The nurse told me at my last smear, last year, and the letter giving me my results said that I had tested HPV negative so they hadn't looked for normal cells. My worry is that I have, in the past, had severe (CIN III) widespread abnormal cells that recurred within six months after my first loop excision, meaning that I had to have a second excision done a year later with much wider margins, so I would be far, far happier knowing that they'd actually checked for abnormal cells. I've had twelve years of clear smears since my last loop excision but the fear is always there.

*Hadn't looked for abnormal cells, that should say.

Only 0.3% of cervical cancer cases are not HPV related. In 99.7% the woman is HPV positive. And of these, most of the 0.3% were caused by in utero DES exposure which was banned in 1971. So really the risk is vanishingly small.

The 70% you read is probably related to the two worst strains of HPV which by themselves cause 70% of cancer cases and are the ones in the HPV vaccine.

Yanbu I had to have a lletz procedure due to severe cell changes, I was hpv negative. I'm worried women like me are going to get missed

I had to explain allbthis ^ to my GP recently, which was a bit puzzling

HPV is just spread through sex right?

So as someone who was a virgin when I met DH, as was he, why am I putting myself through painful smears if they only test for HPV?

This actually deeply concerns me as I had advanced abnormal cells (CIN3), had to have a colposcopy, and lletz twice to get rid of them and I am hpv negative. I absolutely would be dead by now if this policy was around then. I was 28 at the time.

As others have pointed out the percentages are very much higher than you've quoted. To screen every HPV neg smear would completely overwhelm the NHS cervical screening labs.

The evidence shows this new way of cervical screening prevents more deaths. That’s the aim of any mass screening programme. It seems counter intuitive but there have been huge research studies.

@Hopoindown31

As others have pointed out the percentages are very much higher than you've quoted. To screen every HPV neg smear would completely overwhelm the NHS cervical screening labs.

Did we not used to examine every smear anyway, before this??

^ we absolutely did used to examine all. It's a cost cutting measure.

The fact there's already 3 women on this thread that have had severe abnormal cells and are hpv negative speaks volumes about the safety issues of this new policy.

I am also HPV negative with previous abnormal cells requiring loop excision. OK 99.7 is high but its not that high! That's still 3 in every 1000 women. I have 1000 Facebook friends!

Hpv spreads from skin to skin contact, not just through sex

I cried in my last smear when they explained it to me. Then they were really pissy with me when I didn't want to go through with it as I know I am HPV negative & have no doubts about my/husbands fidelity so couldn't have caught it.

Is it not possible that the people who had previous abnormal cells were HPV +ve at the time, but are now -ve? I was +ve three years ago but now -ve.

That's interesting @megaclutterslut, presumably genital skin though?!

I also had CIN3 7 yrs ago. A repeat smear after the procedure came up as HPV negative. I asked 2 different GPs about this and they said I likely had it but that my body had cleared it?

It's all about risks. They've sat down and worked out what to test for based on the outcomes from a false negative (cancer not detected when it is there) Vs a false positive (a healthy woman is told she has cancer and given unnecessary treatment).

If you're HPV negative, the risk of having an unnecessary procedure when your cervix is actually healthy is much higher than the risk of missing cancerous cells. So if you're HPV negative they'll only do additional screening if you're also experiencing symptoms of cervical cancer.

The lletz and colposcopy have their own risks - they absolutely save lives if done on cancerous cells, but they might also increase the chances of problems during pregnancy : fn.bmj.com/content/95/Suppl_1/Fa55.3 So doctors don't want to perform them unnecessarily.

This is also why HPV vaccination is so important for teenagers - it massively reduces their chances of cervical cancer! If you were vaccinated against HPV before you became sexually active there's not as much point in routine cervical screening as your overall risk is reduced so much.

There is another thread currently on women's health board talking about going from negative to positive HPV

@corrag absolutely. Normally the immune system clears HPV within a year or two.

We know persistent High Risk HPV (HR-HPV) infection is a risk factor for high grade cell changes - hence why women with HR-HPV but no cell changes are invited back for a repeat smear after 12 months.

It's not purely a cost cutting exercise - research has strongly shown better outcomes (and less unnecessary colposcopy treatments) with primary HPV testing. It's also a precursor for urine home HPV testing.

HPV can be spread by any skin to skin contact, not just by penetrative penile sex. Lesbians can get HR-HPV too, and using sex toys can transmit HR-HPV as can digital penetration.

@TheGoldenApplesOfTheSun

It's all about risks. They've sat down and worked out what to test for based on the outcomes from a false negative (cancer not detected when it is there) Vs a false positive (a healthy woman is told she has cancer and given unnecessary treatment).

If you're HPV negative, the risk of having an unnecessary procedure when your cervix is actually healthy is much higher than the risk of missing cancerous cells. So if you're HPV negative they'll only do additional screening if you're also experiencing symptoms of cervical cancer.

The lletz and colposcopy have their own risks - they absolutely save lives if done on cancerous cells, but they might also increase the chances of problems during pregnancy : fn.bmj.com/content/95/Suppl_1/Fa55.3 So doctors don't want to perform them unnecessarily.

This is also why HPV vaccination is so important for teenagers - it massively reduces their chances of cervical cancer! If you were vaccinated against HPV before you became sexually active there's not as much point in routine cervical screening as your overall risk is reduced so much.

Can you share the symptoms of cervical cancer for us all please? Just so we know.

So as someone who was a virgin when I met DH, as was he, why am I putting myself through painful smears if they only test for HPV?

Depends on how one defines virgin - it can be transmitted through oral sex, sexual skin to skin contact, sharing toys...

Also, other health concerns can be found during a smear. During my latest one, a polyp was found, the sample was taken from it and I was able to discuss my options about it in relation to my medical history.