By continuing to use the site you agree to our Privacy & Cookies policy

Cervical screening

Cervical screening is a method of preventing cancer by detecting abnormal cells in the cervix (neck of the womb) early on.
Brought to you by NHS Choices

Overview

Introduction

Cervical screening is not a test for cancer, but checks for cell changes that may, if left untreated, go on to develop into cancer. In many cases, cell changes will go back to normal on their own. In some cases, the abnormal cells will need to be treated.

Introducing Nursing Times Learning

Online training units, written and reviewed by experts. Earn two hours’ CPD and a personalised certificate for your portfolio.

Subscribers get five FREE learning units and non-subscribers can access each learning unit for £10 + VAT.

Click on the topic below to get started:

The NHS Cervical Screening Programme aims to reduce the number of women who develop cervical cancer and the number of women who die from the disease. Being invited for cervical screening does not mean you are particularly at risk from cervical cancer – all women aged 25 to 64 are invited.

Attending screening regularly should mean that any abnormal changes in the cervix are identified early on. If needed, treatment can be given quickly to prevent cancer developing.

Why it should be done

Why a cervical screening test should be done

Changes in the cells of the cervix appear to be caused by certain types of the Human Papilloma Virus (HPV). This is a very common viral infection passed on during sexual intercourse. Often, your immune system will get rid of the virus without you ever knowing you had it.

Cervical screening checks the cervix for any abnormal cell changes. If any changes are found, your GP will discuss with you whether to wait and see if the changes go away on their own or if you need treatment.

When it should be done

When a cervical screening test should be done

The NHS Cervical Screening Programme in England offers free tests to women between the ages of 25 and 64.

Women who are registered with a GP are invited for screening tests based on a call and recall system. You should receive your first call for screening at 25. Unless any follow up tests are required, you will be recalled for screening after the appropriate interval. It is therefore important that you ensure your GP has your correct name and address details. You should inform them if these change.

 

 

 

In 2003, the NHS Cervical Screening Programme was changed so that women are offered screening at different intervals depending on their age. Research shows that this change will make the screening programme more effective. The new screening intervals are:

  • Women should receive their first invitation for screening at 25.
  • Women aged 25-49 are invited for screening every 3 years.
  • Women aged 50-64 are invited for screening every 5 years.
  • Women aged 65 or over are screened only if they have not been screened since age 50 or have had recent abnormal tests.


If you are unclear when your next screening test should be, or if you have any questions about the NHS Cervical Screening Programme, you should contact your GP or practice nurse.

If you have not had a cervical screening test within the appropriate time, you may be offered one when you visit your GP or family planning clinic for another reason.

If you have had treatment for abnormal cervical cells, you will be asked to attend screening annually (once a year) for some years afterwards (the length of this depends on how serious the cell change is).

Who can use it

Who can use a cervical screening test

All women between the ages of 25 and 64 have access to free cervical screening tests through the NHS.

Women who are registered with a GP are invited for screening tests based on a call and recall system. You should receive your first call for screening at 25. Unless any follow up tests are required, you will be recalled for screening after the appropriate interval. It is therefore important that you ensure your GP has your correct name and address details. You should inform them if these change.

Cervical cancer is rare in women under 25. Young women’s bodies are still developing and changing, and they may have an abnormal test result when there is nothing wrong. This could lead to unnecessary worry, so screening women younger than 25 may do more harm than good. If you are under 25 years old and worried about the risks of developing cervical cancer, or about sexual health generally, you can contact your GP or local GUM (genito-urinary medicine) clinic.

Cervical cancer is also very rare in the following cases:

Women who are not sexually active:

  • The risk of cervical cancer is very low in women who have never been sexually active. As the risk is so low, women in this category might choose not to have a cervical screening test. However, if a woman is not currently in a sexual relationship, but has been in the past, it’s a good idea to continue with regular cervical screening.

Women over 65:

  • Women aged 65 and over who have had three normal test results in a row are not called back for further cervical screening tests. The way that cervical cancer develops means it’s very unlikely that women in this category will go on to develop the disease. Women aged 65 and over who have never had screening are entitled to a test.

Women who have had a hysterectomy:

  • Women who have had a total hysterectomy (i.e. they no longer have a cervix) will no longer be invited to attend cervical screening. Women who have had a hysterectomy which has left all or part of the cervix in place will be invited to screening once their post-operative care has finished.
  • Women who have had a total hysterectomy for the treatment of cancer, or who had CIN (a type of cervical cell change that can lead to cancer) at the time of total hysterectomy, will have vault sampling. This is when a sample of cells is taken from the vagina near where the cervix used to be. Vault sampling isn’t part of the cervical screening programme - it is part of the follow-up treatment for hysterectomy.

How it is performed

How a cervical screening test performed

You will receive a letter from your local Primary Care Trust or GP asking you to make an appointment for a cervical screening test. You can have the test carried out at your GP surgery or a family planning clinic. Most women choose to have their test taken by their GP or practice nurse. You can ask to have your test taken by a female doctor or nurse if you prefer.

The screening test is best done in the middle of the menstrual cycle (between periods), so you need to book your appointment accordingly.

The cervical screening test doesn’t take very long - usually around five minutes, but sometimes slightly longer. It may be a bit uncomfortable or embarrassing, but for most women it isn’t painful. If you do find the test painful, tell the doctor or nurse taking it because they may be able to reduce your discomfort. Although it can be difficult, you should try to relax as much as possible, as being tense makes the test harder to carry out. Try taking slow, deep breaths.

You will be asked to undress from the waist down and lie on a couch. The doctor or nurse will gently put an instrument called a speculum into your vagina. This holds the walls of the vagina open so that the cervix can be seen. A small spatula or brush-like instrument is then used to gently wipe some cells off the surface of the cervix.

The cells from the spatula or brush are put onto a glass slide, or into a vial, and sent to a laboratory. The laboratory staff will look at the cells under a microscope to see if any abnormal cells are present. The results will be sent to you and to your GP. If any abnormal cell changes are found, your GP will discuss with you whether treatment may be needed.

Results

Results of a cervical screening test

When you have the test, the doctor or nurse will tell approximately how long it will take for you to get your results. Make sure you have received this information before you leave the surgery or clinic. The results are usually available within six weeks from the date of the cervical screening test, but in some cases the waiting time may be longer.

If the results show abnormal cell changes (dysplasia), further investigation may be necessary. Depending on the degree of change, your GP will arrange for a second cervical screening test or will refer you to a gynaecologist for an examination called a colposcopy. This procedure uses a low-powered microscope to look at the cervix in more detail and decide on the best course of treatment. If necessary, a biopsy can be taken from the cervix for diagnosis. Not all abnormal changes need to be referred for colposcopy or treatment - sometimes your GP will recommend simply waiting to see if the changes disappear on their own.

The medical name for cervical changes is cervical intra-epithelial neoplasia (CIN). CIN is not cancer, but in some cases can go on to develop into cancer. CIN 1 refers to mild dysplasia, CIN 2 to moderate dysplasia, and CIN 3 to severe dysplasia. A biopsy can also identify rare cases when cells have progressed from dysplasia into cancer.

A small number of women are asked to return for a second cervical screening test because the first one was inadequate. This means the laboratory was not able to analyse the cells from the first test. This may be because of blood in the sample making the cells difficult to see, or because not enough cells were collected to give an accurate result.

Advantages

Advantages of a cervical screening test

Regular cervical screening detects cell abnormalities early on, before cancer has even had a chance to develop. It is very rare for cancer to be found at cervical screening. In England and Wales, cervical screening saves up to 1,000 lives a year.

Disadvantages

Disadvantages of a cervical screening test

As with all screening tests, cervical screening is not 100% accurate. Regular screening can stop up to 75 per cent of cancers developing, but it does not prevent every case.

It is not yet known which early changes in cervical cells will later develop into cancer and which will not. This means that some women will be treated for abnormalities that may have cleared up on their own.

Expert view

Gynaecologist Andy Nordin on the questions to ask

A smear test is a screening method to detect pre-cancerous cells of the cervix. We asked Andy Nordin, a gynaecological oncologist at Kent and Canterbury Hospital, to tell us what women need to know about this important test.

At what age should women have their first smear test?
You should receive your first call for screening at 25.

How often do I need to have this test?
Women between the ages of 25 and 49 are invited for a screening every three years. Women between 50 and 64 are invited every 5 years.

What are you testing for?
Cervical screening is not a test for cervical cancer. It’s a test for cervical pre-cancer (called CIN), the cells that are present before cancer develops.

What does it mean if I have an abnormal smear?
If you’re referred to hospital because of an abnormal smear test, this means you have pre-cancer, not cancer. You’ll have a small procedure under local anaesthetic, which will prevent cancer forming. About 95% of women who have high-grade pre-cancer changes treated find that their smears go back to normal and they don’t have any more problems.

Why do women get pre-cancer?
It’s caused by an infection with a virus called HPV (human papillomavirus or the wart virus). There are certain types of HPV that make you more likely to develop pre-cancer and cancer of the cervix. These high-risk HPV infections are extremely common.

How common are HPV infections?
By the age of 50, 80% of women will have been exposed to the virus. At the age of 20 around one in three women will have an HPV infection; at the age of 25 it’s about one in four, and by the age of 35 it’s about one in eight. While it’s very common to get the infection, most women (and men) clear the infection through their immune system and the HPV goes away.

If HPV is cleared, do you still need to have smear tests?
If the virus goes away, you’re unlikely to develop any further problems in the cervix, but it’s important to stay within the screening programme. After treatment for pre-cancer, women come along and have a smear test every year for 10 years to make sure the changes don’t come back. After that, they go back into routine three-yearly screening.

What effect has cervical screening had over the years?
Since the cervical screening programme was established in the UK in 1988, there has been a fantastic reduction in the number of cases of cervical cancer and also in the death rates for cervical cancer. Cervical cancer is one of the few cancers where we can detect the pre-cancer changes, treat the pre-cancer and stop the cancer from forming. I can’t emphasise strongly enough how important it is to have a regular cervical smear test.

Useful links

NHS Choices links

External links

This article was originally published by NHS Choices

Have your say

You must sign in to make a comment.

Related Jobs

Sign in to see the latest jobs relevant to you!

newsletterpromo