Cervical Smears-Not to Go?

[B1rthdayD1lemna]

So I’ve always been very compliant with anything medical but after a number of really bad experiences (most NHS but some private) I’m now more sceptical.

I’ve been invited for my latest smear test, and inspired by another current thread on women’s health, I wanted to ask IABU if I don’t go?

I know for some people smears can be painful and even traumatic. I’ve been lucky not to have been in that situation. However, I am concerned about the downsides-mainly, the risk of false positives. Basically where something “abnormal” is treated but where it wouldn’t have actually caused harm. I think these are a recognised downside for preventative screening programmes, but I don’t know what the risk is for smears and breast screening. I’m not in an at risk group so far as I know. If I noticed a problem I would definitely get it checked out but just want to take a risk-based approach.

Yes. I know. I’m talking about the risk of non-HPV related cancers. Which we were warned about when the HPV vaccine was rolled out. I know I don’t have HPV. It’s too long since I was sexually active. I’d like an actual test.

Yes. It was. But I think it’s silly. There is some risk of non-HPV related cancers women go through an invasive test. They deserve it to be looked at, even if it doesn’t make financial sense.

This is what I’m getting at. Why do the invasive and uncomfortable test for everyone if you aren’t going to look at it? I’d be happy to have an HPV swab, self administered if that’s accurate enough, despite being as close to 100% certain as I can be that I don’t have HPV. I deeply resent the painful (for me - tilted cervix) test being done when I know they won’t even look at it. I intended to miss my last one, but then I needed another gynae procedure and the nurse offered to do it at the same time.

You are wrong to assume that you don't have HPV. The virus can be dormant and then reactivate.

I also had a general going over at my last smear, because I'd reached fifty and am on HRT. Blood pressure, weight, lifestyle questions. It wasn't just lie back and get it done.

Would not want to play roulette with my health. I'd go.

The NHS does not offer vaginal swabs for testing for hpv, it only tests for hpv using cells obtained directly from the cervix, so, effectively, regardless of whether you are just having a “smear test,” just having an hpv test, or using the cells to test for both, you will have to go through the same painful procedure.

It is possible to buy a vaginal-swab hpv test for £55 from Superdrug, do it yourself and send that off. You are then reliant on your own technique being adequate. If the NHS moved to doing vaginal hpv tests, it would magnify the discomfort, time and stress of the women who do have positive hpv tests, because they would then have to go back to the doctor for a cervical cell scrape to do the smear test, in any event.

It is worth remembering that a negative hpv test does not mean you do not have hpv, it can mean your hpv infection is currently dormant. That’s why, even if you are happily married with a partner you are confident is entirely faithful to you, and you have had several negative hpv tests, this doesn’t mean you can be certain that you will never have a positive hpv test. Any challenge to your immune system (eg stress, nasty illness, pregnancy) could be enough to encourage a dormant infection to come back to life and start causing abnormal cell changes (and then potentially become dormant again if your immune system gets on top of it once more - although the reason high risk hpv strains can cause cancer is that they are good at “hiding” from the immune system).

You know what’s painful and traumatic?

Dying of cancer because you didn’t go for your smear.

Theyre not faffing around in people’s vaginas for fun, they’re trying to diagnose early, treat and prevent cancers that often don’t become symptomatic until it’s too advanced to treat effectively!!

I haven’t been sexually active for almost 3 decades. I’ve had smear tests the whole time. I think it’s deeply unlikely.

So everyone has to have the more unpleasant test because some people will need it? That doesn’t seem sensible.

I go because a really lovely friend of mine had abnormal cells on hers and was almost insistent (in a sweet, caring way) that I go because I told her I wasn't going to.
I went.

My GP offered me a smaller, plastic speculum when I was struggling and uncomfortable with the bigger one. If that would help you, I would ask xxx

Stop being a half-wit and get on with it. Honestly, I really don't know!

I have a tilted cervix so it's not great but I would far rather have the test than not.

It doesn’t seem sensible to want a smear test done when you are hpv negative, yet still you want it.

Even in the US, where NHS cost-saving is not a factor, hpv tests tend to be done by taking cervical cell samples, not offering vaginal swabs. There may be a case for letting people with an extreme phobia of internal examination use self-administered vaginal swabs (even if a less reliable method) and to miss out on the additional protection of someone trained in the procedure visualising the cervix and vaginal canal and doing a thorough sweep of the cervix to minimise the chances of an inadequate result, but I doubt this alternative is good enough to offer it to everyone. It is more likely it would be offered if it was found to be cheaper, so justifying a small drop in reliability of results and follow up.

I can see why in your case, after so many years of normal tests, you would favour a less invasive procedure, however, even if a bit less reliable, whether done in a surgery or done in the comfort of your own home. I also sympathise regarding the pain - I also have a retroverted uterus and ended up having to insist that only someone trained to do an internal, manual examination should be allowed to look for my cervix, following too many occasions where practice nurses were incapable of finding my cervix, despite vigorously slamming the speculum up against my internal organs for 20 minutes.

I have always had it. What I’m saying is that it’s ridiculous to make everyone have it when they are only actually testing a small number of the samples. In my personal situation it seems unlikely my sample would ever be tested.
And nobody yet has addressed what is happening about cancers not caused by HPV.

It doesn’t seem sensible to want a smear test done when you are hpv negative, yet still you want it
@Walkaround I want it because not all cancers are caused by HPV. But nobody has a test for them now.

It's the system we have now because of the medical knowledge which is currently known.We don't have the ability to identify those women who despite having HPV and dyskaryosis will not go on to develop cancer. In the future that might be possible but we have to deal with the here and now.
Non HPV related cervical cancers are rare, they are likely to develop in the glandular cells which line the endo cervical canal, the smear test is designed to collect squamous cells from the cervix.

And yet the clear message when HPV vaccine was rolled out was that it was necessary to be tested because of these cancers. I’ve said nothing to DD. But as a vaccinated person what on earth is the point?

You can still become infected with HPV even if you are vaccinated, despite the vaccination significantly lowering the risk of infection. No vaccine provides 100% protection.

Endocervical adenocarcinoma is generally associated with high HPV types 16 and 18.
Sampling of the endocervix varies because of physiological factors. It isn't possible to sample all of the endocervix either with a cervex broom or spatula.
You're correct that the screening programme is designed to identify pre-cancerous changes in squamous cells.

It would be if they actually looked at the cells…

Bet men dont get told this. No In that case their female partners get told to cojole them into going.
Can just imagine what you were like during the lockdowns.

Someone has posted a laughing emoji on the thread which is odd.

@HoskinsChoice hasn’t answered my question about what they think a “good reason” would be