To think I may as well ignore my invite for cervical screening

[annlee3817]

I don't take this lightly, but I am HPV negative, I had CIN2 in 2014, and the abnormal cells were removed. I believe that now if I go for a smear, they will test me for HPV and if still negative, they won't check for abnormal cells.... So what is the point in me getting a smear? I thought having had CIN2 they'd check mine on that basis, but apparently not... My cousin had CIN3 and also HPV negative 🤷

I've never said screening is useless.

Quoting you:

But it is HPV only in most places. And you don't need a smear test to check for HPV. So why do women have to go through that if it's not even necessary?

I'm not ignoring it. Everyone has a different measure of risk. For some people, a visual check every year isn't a good enough reason to go through that when they don't have any other risk factors.

You’re ignoring it every time you state the test is HPV only.

it’s not.

People should make decisions based on facts, and other people shouldn’t be influencing those decisions with false information. Which stating the test is HPV only is.

Private smears checks cells as well as HPV.

Why the patronising nastiness to me when I’ve been polite?

I haven’t “hammered” anyone - just pointed out politely that the smear is not, as you keep saying, HPV only.

Why the objection to people having full information?

The OP, as I have said, might not feel comfortable disclosing sexual violence as a reason for not going. She may not even feel comfortable hinting at it. The high prevalence of SV should inform you that she might be a victim. Even if she isn't, SV victims will read this thread, after all, I did.

You can recommend going for smears without resorting to judgemental, dismissive terms like "evolution in action".

This is helpful. Thanks.

@Mumdiva99 that isn’t correct to say all cervical cancer is HPV related. They are not. 90% ish of cervical cancers are HPV linked, so 1/10 women who have cytological changes and pre cancer cells, or even cancer would not be picked up by this new screening. Neither would those who carry HPV, have higher risk, but were negative at testing. The new test also only detects two prevalent strains of HPV, accounting for 70% of 90%. Suddenly feeling quite far off ‘all’ isn’t it? I reviewed pubmed journals about this, this article is about right: https://www.obermair.info/latest-news/blog/how-common-is-non-hpv-cervical-cancer/#:~:text=Non%2DHPV%20cervical%20cancers%20are,their%20last%20Cervical%20Screening%20Test.

I have not seen visual examination for condition or symptom x,y,z communicated as an objective of screening and I have read the leaflets I’ve been sent very carefully. NICE don’t seem to suggest this is the case. https://cks.nice.org.uk/topics/cervical-screening/background-information/benefits-harms-of-cervical-screening/ it may be a side effect of seeing a vagina but if the staff aren’t trained and exposed to enough examples then surely it’s happenstance? Like if I go to the dr with a dodgy back and they look and see a worrying mole; they’d point that out? I also found this when I had a Google ; The CVAG is a visual educational tool developed by health professionals specialising in colposcopy and gynaecology. In response to local trust audit results and regional colposcopy data they suggest some primary health workers’ have little experience of recognising the signs and symptoms of invasive cancer of the cervix. Subsequently, a significant number of women are referred to oncology and colposcopy clinics with suspected cancer of the cervix in the absence of disease. (https://www.newcastle-hospitals.nhs.uk/content/uploads/2020/11/Guidance_for_Good_Practice_-_5th_Edition.pdf) I feel that the benefits of visual inspection are being overstated here and could lead to false reassurance or, as the Newcastle ref suggests, over treatment/ over referral. I suspect that there will be a move to home HPV testing very soon for everyone anyway.

The CVAG? The see-vag?

Notorious for being anti smear tests? Really? Most threads on the topic here are full of nasty, judgemental comments towards women who struggle with barriers to screening or who have made their own informed decision not to, calling them stupid and ignorant, saying they shouldn’t be entitled to NHS treatment if they develop cervical cancer. Even in this thread, we’ve already had the ‘evolution in action’ comment and ‘you don’t get to complain if you develop cancer’. There is a really unkind, emotionally manipulative and bullying tone to conversations about screening in general. It needs to change because no one was ever helped by being mocked and derided.

@SurferRona I said "almost all.....' 90% is almost all.

Can someone please explain to me what this change is please? I last had a smear 10 years ago and I'm apparently due (even though I haven't had sex in 7 years but I'll still need to have it done I presume?) What about them has changed? Google didn't give me any clear answers

Previously, the cells collected in the smear would be looked at for any abnormalities. Now they are only looked at if you test positive for HPV (which is tested for at the same time as the smear). So if you have abnormal cells but are negative for HPV, they will not be picked up, unless something unusual is seen by the nurse and I think in that case they can refer you on for more investigation.

Yes exactly this! I've never experienced any other female/AFAB discussion space where smear tests are vilified the way they are on MN. It's always under the pre-tense of being pro-choice, anti abuse etc. But surely there's a point where medical common sense prevails over the shame of anything related to female genitalia. If you had bowel cancer then you need to get a camera up your bum...probably nobody in the world who finds it pleasant but nobody tries to defend whether it's their "choice" or not.

I know at least 4 friends in real life who had very close calls with cervical cancer at a very young age (pre-cancerous changes, LLETZ procedures or constant monitoring). It's a huge shock and by far the most common cancer scare under 40 than another form. All of them just get on with it and thankfully it has not developed into cancer.

I think there is a lot of misunderstanding about what a 'smear' test is now.

People still think you are getting the cells examined when it only happens if you are HPV positive. It explains it fully in the leaflet when the invite comes through.

I went last time but the next I will pay for a home HPV test rather than have an uncomfortable procedure that is not necessary. Why put myself through more than is needed?

If others what to go that's on them and I would never discourage anyone from doing so but equally it's important that people understand the changes so that they know the cells will NOT be examined unless they test positive for HPV.

Even in this thread, we’ve already had the ‘evolution in action’ comment and ‘you don’t get to complain if you develop cancer’.

I called those posters out on that behaviour because even this autistic woman can see that attitudes like that are rude and hurtful, which means they are probably jaw-dropping levels of rude to neurotypical readers.

I also described my own strategies for coping with smear tests after sexual assault, in the hope that they would help others to go. I hope that I have shown that it is possible to encourage smear test attendance in a way that acknowledges women's reservations about attending and offers support and tips, not insults and shaming.

I would welcome home HPV tests if and only if evidence from large group trials demonstrated that they are as reliable as the current smear tests at detecting HPV and cervical abnormality. I would love to be able to safeguard my health without the invasive and uncomfortable at best, painful at worst (thanks to sexual violence induced vaginismus) exam. However, our collective experience of COVID lateral flow testing indicates that swab-based tests carried out by untrained patients aren't as reliable as those carried out by trained HCPs. At this time, it would appear that NICE don't consider home testing as effective as testing in a clinical setting. Given what I've just said about self-administered swabs being less reliable, I'm not surprised that NICE aren't trusting them.

So I book an early appointment and a full day off work to cope with psychological fallout and I go every three years when I get the recall letter, because as I said already: those bastards took my dignity, they took my bodily autonomy, the first ones took my innocence when I was eight years old, they are not taking my health as well.

Ok so I work in healthcare and also had my smear last year so had this issue explained by the practice nurse who did mine. As others have said it’s HPV only they test for and anything else is only looked at if positive. If negative you’ll be invited back 5 years later if positive they’ll investigate further and I think she said it’ll be more regular than 5 years. We discussed the impact of the HPV vaccine and she thinks that eventually those who have had the vaccine and the next generations won’t need smears as such and are more likely to be asked to do self testing.

as an aside I do not agree with the 5 yearly tests as many have already pointed out and even the nurse agreed, it may be evidence based but it has roots in money saving. She did say that obviously anything out of the ordinary I’d be seen straight away. I think that 3 yearly should have been kept for those of us who have not have the HPV vaccine personally

I hope you have signed a disclaimer then to say you won't expect the NHS to pay for your treatment if you get sick and ignored the screening.

No such disclaimer exists! 🙄🤦🏼‍♀️ Absolute nonsense and you know it

@RightWhereYouLeftMe Thank you for explaining. That's crazy!

The same disclaimer you make a GP sign when you tell them something feels wrong and they offer you antidepressants and it turns out you were seriously ill? Or when someone hurts themselves drunk, or has a smoking related disease, or has unprotected sex and gets an STD, or god forbid someone is overweight. It’s called universal healthcare for a reason.

people also have the right to refuse screening and or treatment. You going to tell someone who chooses to not undergo radical last hope treatment it’s their fault and they can’t have palliative care?

Sorry to hijack but has anyone been referred to the hospital to have their smear? The nurse couldn't do mine as it was far too painful and she couldn't get the speculum in so I am going to hospital on Tuesday to attempt it.

My smears are always painful to be fair and usually take multiple attempts over multiple appointments but this is the first time I have been referred to hospital for it. I am terrified tbh

Thanks to everyone that's commented. I guess I just find the change so frustrating as someone who has had abnormal cells in the past. I'm not making light of it, and before this change was a huge advocate for getting a smear. In previous smears I've had no comment on how my cervix looks, my cervical ectropian was picked up post pregnancy when I had recurrent bleeding and asked to be referred for a colposcopy, so I was doubtful that anything would be picked up in a smear, always seems to be an in out procedure with no time taken to look. I've had three (one extra) smears since the cells were removed, and all have come back negative for HPV, but didn't realise it could lay dormant. So thank you all for.your input.