Nurse refused to do a smear test

[weevilswobble]

Have been suffering alot of anxiety and part of that is a fear of cervical cancer. I got the HPV virus on my first ever sexual encounter aged 17, and was told i'd need an annual smear. I have had abnormal smears and treatment for abnormal cells in the past but i'm currently on a 3 yr recall. My doctor said to book in for a smear for reassurance, but today at the appointment the nurse refused to do it. Can i go somewhere else? I take full responsibility for my health and dont actually enjoy having smear tests, but its sensible i think. Feeling a bit confused.

Yes MrsJames, at the same consultation when i tearfully explained i was worried i would die and leave my children orphans, she said to get a smear and other blood tests to reassure me i wasnt going to die and also referred for assesment for counselling, the apptmt for which was today, so am on waiting list for counselling now. I feel like such a waste of peoples time

The NHS cervical screening programme is co-ordinated nationally with national guidance and policy documents. The recall intervals have been set at 3 and 5 years (for 49 yo+) for several years now, these were set on the basis of being the most effective and efficient. It's part of what a well functioning screening works on.
Nationally more work is being done to ensure that the coverage of the programme is more effective. That means the right people attending at the right time for tests.
It does not mean those who have been screened at the appropriate time (and however understandably) are anxious - having tests done more frequently.
Your GP should not have told you to book in for a test and the nurse was correct. Years (and I mean 20 years ago) people were told to have annual tests if they'd been exposed to HPV but that was before more was known about the development of cervical abnormalities and HPV.
Now there is more information the guidance was changed in about 1996, with different follow up according to grade of abnormality and any treatment.

Someone who is anxious and has been regularly screened, should be counselled by their GP/HCP about what their worries are about.
If the person has symptoms then they should be investigated appropriately. If you are already up-to-date with cervical screening then that doesn't need to be done. There's been quite a bit of info put out by the PCTs and NHS CSP national office to labs and primary care about not screening outside recall intervals but I guess it hasn't reached every GP yet.

weevilswobble - I don't think you're wasting peoples' time at all. You're worried about something - my opinion is that your GP should be looking after you by suggesting appropriate tests. I guess they haven't had the information about the screening guidance and the nurse has.

Good, that is what you really need, the blood tests, smear tests etc won't actually reassure you, they can make things worse. Getting to the root of all of this is what you need to do and, hopefully, counselling will help you with that.

Health anxiety is a very difficult thing to live with and can quickly get out of all proportion, I hope your appointment comes through soon.

Cognitive behavioural therapy (CBT) might also be something to consider.

You're not a waste of time - I would far rather I had a woman booked in for a smear test that didn't need doing, than for a woman not to come at all!

I do hope your counselling helps with your anxiety; it sounds like you have a kind, supportive GP.

Bela so say you had mid cycle bleeding two years after a clear smear - are you saying that a repeat smear isn't necessary or am I misunderstanding your last paragraph?

I ask because I have mid cycle bleeding, two years since last clear smear and also had numerous hospital investigations for an unrelated gynae thing (hysteroscopies and scans) yet when I've asked if I should ask for a smear for the bleeding they say no. That tallies with what you say so I'm interested.

Coldsancerre, swabs would be a good idea, if you have a history of cervical abnormality then a referral for colposcopy. A smear isn't the right way to go.

GP is lovely, nurse is a bit of a cowbag. I understand the guidelines, but have had abnormalities before and know someone who has cervical cancer, who hadnt had regular smears and a lovely friend and neighbour died recently mid 30s from breast cancer.

Thank you lovely MNers for being there and adding your kind words.

Weevil, these experiences has increased your anxieties. You have had regular smears, you are on the 3 yr recall which the majority of women are on. I guess you are breast aware and would seek help if you were suspicious about anything.

MrsJamesMartin agree entirely with your last two posts re Coldsancerre and weevil.

Coldsancerre there's two parts to this 1) technically you are due for an NHS screening test, however if you've had a private one and you're under/have recently been under gynae investigation then it may not add anything. Does it say anything in the gynae correspondence about further cervical tests.
2) mid-cycle bleeding is not an indication for a cervical screening test in regularly screened woman. Investigations such as swabs, scan (US/transvaginal) and hysteroscopy (dependent on individual's histories) are. IIRC a visual speculum inspection of the cervix should be done as well. Sometimes an inflamed ectropion (thin cervical skin can bleed easily and can be treated with cautery) Have you had a colposcopy as part of your investigations?

Have any of your HPC said whether they think the mid-cycle bleeds are connected to the other problem?

Swab for abnormalities, not HPV. OP knows she has HPV, and is therefore at a higher risk of developing cervical cancer.

Dare I suggest that it is highly irresponsible of the PCT's to put women with HPV on a normal 3-5 year smear schedule. I really don't care how slowly cervical cancer develops, smears are not 100% reliable and I would hate to be misdiagnosed as having a normal smear and then have to wait 3 years to find that I have a potentially life threatening disease that could have been caught early with regular screening!

OP, go private if you have to, otherwise go back to your GP, they can also do smears, it's not limited only to nurses.

MrsJamesMartin are you a fellow cytologist by any chance?

Sorry to hijack OP.

Bela & MrsJM the other problem is recurrent miscarriage so the bleeding is unrelated. I had swabs done two years ago they were clear. No problems with my cervix ever. I'm not massively worried as various consultants aren't just always thought I needed a smear. Maybe I will pop and see my GP if he bleeding continues (I've had hormone treatment recently as part of the rmc treatment so my cycles are a mess right now so will let that settle down) as he's ex-Gynae and very good. TBH I think it may be stress from all the other stuff.

Banana - HPV does go away again. If someone's had abnormals with treatment and/or follow up then they may not have it now. The NHS CSP has groups of people at Cancer Research UK who look at screening histories, abnormal rates, who develops cancer and when. This information is used to set the policies and the screening intervals. Please have a read of the info on the national website, the publications section contains all the national docs with refs to the evidence for this so you can see what its based on.
Going to the GP to get a smear done in the OPs I feel won't help because the lab won't process it and the PCT would be likely to contact the GP to find out whats going on.

Coldsancerre not my area but if your hormone levels have been variable (sorry to hear about your MC) that could possibly be a cause.
Keeping your GP in the loop does sound like a really good idea if its not settled, and if its already been going on for awhile then might be worth seeing them for an appt.

I remember afew years ago when you could just walk into a family planning centre and get a smear done, I dont suppose that happens now? I do think you can over test to be honest. I have a friend who goes privately and she gets called back all the blinking time. Im sure its because shes paying for it.

Bela- yes, some types of HPV go away, others do not. I, for instance, have the type that does not go away, even though i have never had genital warts. I only found out after an abnormal smear and then a test for HPV. This was in the US though where things are different and you are given a smear on an annual basis.

Did jade goody not teach us anything about cervical cancer and the importance of smears?

Why didn't you tell her to go and check with your GP while you waited. GP pulls rank over nurse.

The US has a different way of looking at things: its called medical insurance.
The sad and untimely death of Jade Goodey taught us several things.
One, go for screening when appropriate.
Two, go for treatment, have the treatment and go back for more treatment if you need it (she did an interview where she said she hadn't gone back for treatment because she'd found it painful).
Three expect lots of women to attend for screening all at once because of the media coverage. Overdue and unscreened (& eligible women) great, "worried well" not so helpful. Screening staff take at least two years to train (15+ yrs for senior staff) so you can't suddenly put more staff on if you get x3 your normal number of samples to screen, which then takes weeks to catch up.
All the samples are read by people not machines.
Its difficult to plan for an unknown workload. The way women are usually called for screening means its spread out across the year more.

We have had to plan from now how to deal with all the extra work we'll get next spring with the 3rd anniversary of her death. Basically pretty much no leave to be taken for a couple of months.

ChippinIn as I've and others explained upthread, the GP shouldn't have suggested having a smear test for the reasons given. The local lab would have most likely not processed the sample and the PCT would have been in contact with the practice to find out why they'd taken a out of programme sample. See explanations upthread re unscheduled screening and in/appropriate testing.

The nurse's bedside manner is obviously lacking. Why couldn't she have explained properly that the NHS will only do these tests every 3 years and then told you about options (ie going private).

I used to do this OP as I too had HPV virus and had laser treatment on my cervix (15 years ago).

I would also add that in France and Australia (as well as a poster stating above in the USA) smears are carried out annually. I don't think these countries would be doing this if they didn't think it was necessary, do you?

Lebag, i had laser treatment too. Made me feel like stuff can be going on down there without you ever knowing.
Banana, you seem to understand exactly where I'm coming from!
Chippin, if a bossy old nurse says she wont do it, i'm going to skulk away in an embarrased manner not stamp my foot in a demanding manner and have her over ruled and have her do it against her will. Its bad enough having one when you feel welcome! Also my nice lady GP only works 2 days at the practice, rightly so coz she has 2 little ones. I'm feeling anxious and low for lots of reasons af the mo, so not my usual very assertive self.
So, is there an HPV that goes away?? When i was 17 had all the lovely warts and loads of laser treatment for that. So can you have a blood test to see if its still in your system?

Bela and sidge, thanks for your brilliant professional input!

OP there is something that does go away. Sorry I'm a bit vague but a couple of years ago I had a test which showed that I was not in a high risk anymore. Don't know if it was the HPV virus that had gone or levels of something had gone down. Anyway what it means is that I can go back to regular screening progams. Ask your GP about it.