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.

Dear lord sofabitch, she only wants an annual smear! Hardly an overreaction, given she has HPV and was told she would need annual smears!!! OP, you don't need CBT just because you want an annual smear. FFS!!

banana87 - OP has been referred for CBT because her anxiety and stress extend beyond worries over her smear test. She has been put back onto 3-yearly recall I presume because she has now had normal smear tests for quite a number of years since her last treatment for cervical abnormalities and so is no longer entitled to annual recall. I had treatment for CIN3 a few years ago (following 5 years of on and off abnormal results) and am fully aware that after 10 years of normal annual results I will automatically be put back onto 3-yearly recall, despite the fact it is quite apparent that I have or have had high risk HPV and my body has in the past not done a good job of dealing with it. If I were absolutely terrified of dying of cervical cancer after 10 years of clear smear test results and having been informed that I was no longer considered to be at high risk (which is what return to 3-yearly smears tells you), I would personally view that as being excessive anxiety. Yes, it may be effectively dealt with by allowing annual smear tests, but I doubt it, because people don't normally have such high levels of anxiety over a single issue - they normally have an awful lot of other stressors in their life at the same time and could do with help dealing with their stress and anxiety in general rather than pretending it's a single-issue problem.

rabbitstew I appreciate that the OP may have other issues that would require her to seek CBT, I just don't think she is overreacting here.

I believe that the NHS is careless in placing women with some (note: not all) types of HPV on 3 yearly recalls. I 100% believe this is simply to "save money" rather than smears not being medically necessary more often than that. Many many countries offer annual smears, and I think it is not without justification that they do so.

There's quite a few issues I don't know where to start really!
I guess my first point is trying to separate out (a) the individual's concerns for their health and (b) screening to prevent a disease (c) what is detected by any given screening test

(a) depends on many factors and peoples' perception of their risk of developing a disease can be more or less than their actual risk.
(b) I've linked to a useful article to read about screening in general, why certain diseases are suitable, what a suitable screening test is, what a diagnostic test is and the limitations of screening
BMJ article about screening
(c) ref in particular to cervical screening - it's not a perfect test. It picks up cell changes that can be due to transient HPV, due to inflammation/hormonal changes and changes due to pre-cancerous conditions. Detection of pre-cancerous changes (dyskaryosis or CIN) doesn't mean they would progress to cancer if untreated. Low grade changes will often go away (and are probably related to transient HPV). High grade changes are more likely to progress (but still not certain). The progression does usually take many years (10-15) so this is why the disease is suitable for screening.

Screening intervals aren't just about money - it's about trying to balance out what is detected when. The more frequently you test, you are more likely to pick up changes due to infections, and transient HPV which would go away on their own, but are then into a cycle of repeat tests and treatment. Screening is a fine balance to get the right people at the right time with test set at the right level.

Comparing the NHS CSP with other countries' screening isn't quite like for like. For example, there is no national screening programme in the US. They have recently started quality controls and proficiency tests but both they and many European countries do not have the structured quality controlled programme we have. The lab screening staff are monitored every day, our performance stats examined, we have regular external tests to pass. Our data is looked at by a regional QA team on a monthly basis.
The training for a basic screener is 2 years with a diffficult exam at the end. The senior staff have an MSc and the most senior staff have a PhD equivalent qualification and take an exam that only about 25% of people ever pass.
This is part of the reason why we can have more extended screening intervals because of the work that's gone into to making it so tightly and rigorously controlled. I attended a conference fairly recently where a delegate from a French lab presented data showing that their sensitivity had dropped with introducing a new technique (i.e. they were now missing some abnormal results) which meant they could report more samples quicker. She said she was comfortable with this (i.e. knowing that some women were having abnormal results missed) because it was all insurance funded so they would be coming back next year, so it didn't matter.

Thanks for that info Bela. You are very knowledgeable :)

As a patient with the type of HPV that I have, I am more comfortable being screened annually. I am willing to pay for this privately if I have to, just for peace of mind.

OP, Marie Stopes is offering half price smear tests, you can have a look at their website. £55 I believe.

Kitya, i didnt have a smear at 17, i just had lots of lovely warts! Took myself off to a hospital clinic by myself that i'd seen advertised on the back of a public loo door! < sad 17yr OP>

That's a bitch. Why don't you pay for the £55 test if that will ease your mind? I would if I was you and were worried about it.

I read an article today re the US which said that between the age of 20-30 they recommend two-three yearly testing and, after 30 three yearly. Not really any different to us.

You are lovely ladies. Bela, rabbitstew, ledkr, i love you.

And kitya, love you too.

And banana.

Thank you, weevils...

I guess you've had a CIN/dyskariosis result from a smear test as well as having had visible genital warts? (Visible warts aren't caused by a strain of HPV that is likely to cause cancer or CIN).

There appears to be alot i dont know. I just thought HPV was HPV, now it appears there is a cancer one and a not cancer one. Dont know which i have.

Ah thanks weevils lets unite in our scraped cervix's

I would pay.When i found my lump i was low risk-26,had kids early and bf them,vegetarian,no family history.It was going to be ages before i saw a consultant so i paid £70 at the time.It was positive,i had had surgery and started treatment before id have even had the forst consultation.
I now have annual screening for ovarian cancer,its not that reliable but its all they can offer at the mo and it puts my mind at rest.
One thing i learned is that you alone are responsible for your own health,make a noise and be counted. They werent even doing chemo in my local hospital when i had mine,i researched it and insisted on the chemo,a year later they were giving it to all women.
Was that a wastae of nhs resources when people are having fat loss surgery and boob jobs,nah i dont think so.

There are lots of HPVs, whole families of them! The various branches are associated with the development of things like skin warts (e.g on your hand), papilloma, vulval and vaginal warts and also development of CIN. Lots of people have HPV of some sort and it mostly goes away again.

More info about HPV on the colposcopists' website.

Hi, weevils. There are tonnes of strains of HPV, most of which don't cause cervical cancer. Of the strains of HPV that affect the genitals, types 16 and 18 are the most common cause of cervical cancer in this country and they never cause visible genital warts, just microsopic changes to the cells (normally of the cervix) which can be detected by a smear test. If you've had visible genital warts and that is the only strain of HPV you have, then you really aren't likely to get cervical cancer. However, since HPV is such a common virus, you may well have managed to catch more than one strain of HPV. If you've ever had CIN1, 2 or 3 (sometimes described as mild, moderate or severe dyskariosis) then you more than likely have also had a high risk strain of HPV infection. If not, then just because you've had genital warts, it doesn't mean you are actually at high risk of cancer at all.

What is dyskariosis?

Its a greek word used to describe the changes seen in the nucleus of abnormal cells. Dyes are used to stain the cells and this highlights the changes. Its used in cytology, which is the speciality that does the screening of 'smear' or cervical screening tests.

CIN = Cervical Intraepithelial Neoplasia. This is the pre-cancerous changes and is also used to describe them when examined on histology samples. Histology is the sibling speciality to cytology where the structure of tissue rather than cell detail and patterns are examined. Its whats done with biopsies and LLETZ/loop treatments.
Both are done under the microscope. Cytology tends to be screening staff and scientists with a mixture of consultant scientists and medics (pathologists) reporting the abnormal tests, histology has more medical staff doing the reporting.

Ahem sorry not v.good at short answers

Havent read through everything so apoligies if already answered. Have you asked your doctor to refer you to a smear. Complain about bleeding, pains, or something so that it gets checked out.

I was on 6mthly for years and it changed to annually, but new doctor has recently changed it to 3, but there is no way I will be waiting for 3 years.

Hi iamseeingstars - in answer to your questions

1. in her OP she says the GP suggested a smear
2. she can't have one out of screening programme
3. the reasons for this has been answered in detail by various posters in including myself.
4. You will also have to wait 3 years for your next one - please have a read through the thread for the explanations.

HTH

Iamseeingstars, this whole thread is worth reading! Some posters are professionals and really know their stuff.

Nice one bela. Many thanks.

Iamseeing. Are you suggesting the OP lies to get a smear?? Don't you think that is morally wrong ?

As a cancer victim, who wont be alive in 3 years for my next smear, I didnt push for further action at a time when a problem could have been identified and rectified earlier, I would definitely advocate that if you are unhappy about something then you push for tests, no matter what the complaint/concern/problem is

It is not morally wrong to want to stay alive