Is there any point in going for a smear test any more?

[keybear]

As I understand it, they test you for HPV and if negative, they don't bother testing the cells.

So is there any reason why I shouldn't just do a home HPV test and book a smear ONLY if that comes back positive?

I would be staggered if I'm HPV positive due to my (incredibly limited) sexual history and I would rather avoid the discomfort and inconvenience of the smear test if they're just going to bin the cell sample without testing it.

I feel the same and haven’t had one. My friend who is a gp thinks there’s something to be said for a visual and manual examination of the cervix

I suppose the only thing is that an experienced HCP might visually spot something but that doesn’t seem massively likely so self swab all the way here.

I know I’m hpv negative so I only go for the visual check. Very annoying to have to go through it (I’m one who finds them very painful) when you know they won’t look at the cells.

I am concerned about this. Having had a CIN3 and subsequent surgery I was before and after HPV negative and this would not have been picked up.

I was wondering the same.

It all seems pointless if they’re not going to look at the sample.

I am also worried about this possibility.

Can anyone who knows more about the medical side of things say why they've decided to change the policy, when this seems like a very obvious risk?

I was wondering the same. I find smears so painful and so don’t want to go through it for no reason if I can do a swab test at home

I had one done at colposcopy recently and the head of department told me that 'soon you'll be doing it yourself at home' so essentially just like a home test you would buy privately I suppose.

Do they really do a visual examination of the cervix though? Surely they just swab and get out?

I asked the nurse about this at my last smear. She said basically the percentage of cervical cancers that are not caused by HPV is so small that it isn’t cost effective for the NHS to provide screening for that. It’s a decision based on cost vs risk similar to why mammograms are only offered to 50+ women even though younger women do get breast cancer. She said that’s why it’s important (just like with breast cancer) that we participate by remaining alert to symptoms and getting them checked out. I think there is some value in the visual check so I still go, but then again I don’t find them particularly painful so I wouldn’t blame others for swabbing at home

@keybear - Basically it is extremely rare to get cervical cancer and be HPV negative. If you are HPV positive, you are at higher risk for cervical cancer, hence your cells will be looked at as a next step.

I believe the policy changed in 2019/2020, and now an initial HPV assessment is done prior to cells looked at for this reason. Until this changed. lots of women would show normal cells at their routine smear, but then present with inflammatory changes 3 years down the line. They were then tested retrospectively for HPV and the link between HPV positive and inflammatory cells became very clear.

I came back HPV positive recently but with normal cells. I was called back for another smear in 1 year, rather than 3. If I am negative in a years time, I will then have 3 yearly smears as usual.

It is really important to note that the virus can remain dormant in your system - and reactivate, and cycle between the two throughout life. You are at higher risk when you are positive, and if the virus is dormant again, your risk is then reduced.

People with only one sexual partner can get HPV - I know, I am one of them! So don't assume if you have a limited sexual history you are clear as that isn't the case.

My consultant told me that often people will test positive years after being with the same partner, as the virus can lay dormant (and reactivate!).

I hope this information helps, I had a bit of a freak out when I tested positive recently as I wasn't expecting it! So I spoke to my gynaecologist who explained all the above.

This link here explains the virus dormancy cycles:

news.cancerresearchuk.org/2021/06/16/lets-talk-about-hpv-6-common-questions-answered/amp/

Hence its so important even if you test negative once to continue getting tested, as the virus may be undetected in your system.

The exact same thing happened to me - it's worrying.

They always say to me - "It looks fine"

This. I was clearly hpv positive at some point and cleared it, but in between smears I had CIN level 2 which will need to be monitored. The biopsy showed it wasn't cancerous at the moment but it needs to be watched.

I wonder what happens if the visual exam isn’t good - do they have the ability to influence the testing of the actual smear even if HPV neg?

I understand all the stuff about HPV being able to lie dormant so the importance of testing for it regularly, but I don't see that can't just be a home swab? There doesn't seem to be any reason for it to be done as a smear test.

That is correct, except its not similar to mammograms only being offered to women 50+ because mammograms cause breast cancer, so you want to limit exposure to the highest risk age range.

For cervical cancer, the Government have accepted the human cost of women dying from it that are HPV negative. I don’t agree with this decision.

No we visually check the cervix. The cells have to be obtained from a specific place so you need to see the cervix clearly. It isn't just a swab at all.
I have referred many possibly pre cancerous polyps for removal in women that didn't even know they had them.

It gets referred on.

Thanks, does that mean they’d examine the smear then? That sounds good if so.

Oh thanks for that, I didn’t know.

I've never had a smear and do HPV self tests. My partner is the only one I've had, and same for him, so I guess my risk is very low anyway, or even impossible?

Do you mean only you had never had a partner previously? Or your partner was also a virgin before you? I know that the former is possible, of course, but I thought I was safer as my partner hadn't ever slept with anyone else previously! Am I wrong?😬

@LT2 - I understand from my gynaecologist you don't need to have sex to catch HPV, oral sex, close touching etc can also spread it. Hope that helps!