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Cervical Smear

Cancer of the cervix can almost always be prevented. Despite this, about 1500 women in the UK die of it each year. Many of these women have not had regular cervical smear tests. Women who have a cervical smear test every three to five years reduce their risk of developing cancer of the cervix by 80-90% because the test can identify women who are at risk of the disease before the disease actually starts. Treatment at this stage does not cure cancer - it prevents it even starting in the first place.

Risk Factors:

Almost all women carry some risk of developing cervical cancer. The risk of developing cervical cancer is increased if you:

• First had sex at an early age
• Smoke
• Do not use barrier contraceptive
• Have had a large number of sexual partners or have a sexual partner who has had many other partners
• Are infected with the AIDS virus (HIV)
• Take immunosuppressant drugs (e.g. after a kidney transplant)

Although the risk of developing cervical cancer is related to sexual activity, virgins can also get cervical cancer, although their risks are extremely low. The NHS offers cervical smear tests to all women aged 20 to 64, regardless of their sexual history.

What is a cervical smear test?

The cervical smear test is not for diagnosing cancer but rather for finding early changes that might become cancer later. All women between the ages of 20 - 64 years are advised to have a cervical smear test every three to five years.

How is the cervical smear test done?

The cervical smear test is a quick and simple procedure in which the doctor or nurse gently inserts an instrument called a speculum into the vagina. This allows the doctor or nurse to see the cervix.

A sample of cells is taken from the cervix and placed (smeared) onto a glass slide. The slide is then sent to a laboratory where it is examined under a microscope.

You may feel a mild sensation when the cervical sample is being taken. The sensation may be a little uncomfortable but it should not be painful. Relaxation can lessen the discomfort. If it is painful tell your doctor.

After examination, there may be a mild spotting of blood for that day. This is normal, but consult your doctor if there is more than a bit or if you are worried.

Ask your doctor when and how you will receive your results. Your results will usually be available within four weeks.

Why is the cervical smear test necessary?

The cervical smear test can detect early changes in the cervix that may be the first warning signs that a problem is occurring. These changes need to be checked as some may develop into cancer. Your doctor will tell you whether treatment will be necessary.

Most cancers of the cervix take ten to fifteen years to develop.

How effective is the cervical smear test?

Regular cervical smear tests every three to five years are effective in detecting abnormalities that may lead to cancer in squamous cells (skin-like cells covering the cervix). This is the most common type of cervical cancer, and early detection and treatment can prevent cancer developing in around 80-90% of cases.

Like all screening tests, the cervical smear test is not perfect. It may not always detect early cell changes that may lead to cancer of the cervix. This may be because:

• The smear does not obtain normal cells that are on the cervix
• The samples may be difficult to interpret if there is blood or mucus on the slide
• Occasionally, abnormal cells are missed under the microscope; and
• Cells from just inside the cervix (where a less common cancer can develop in the glandular cells) are more difficult to collect. (Less is known about the early changes that may lead to this type of cancer.)

The cervical smear test results

Sometimes after receiving your cervical smear test results you may be recalled to see the doctor or nurse again. This is nothing to panic about, because: it does not necessarily mean you may have cancer.

The report may indicate, for example, that the sample was unsatisfactory/inadequate. This can happen for a number of reasons.

• The cervix cells on the slide may have been obscured by blood or mucus:
• There may not have been enough cervical cells on the sample to give an accurate assessment
• The smear may not have been properly prepared; or The slide may have been broken

If any of these problems occur, you will be asked to have another cervical smear test a few weeks later.

Inflammation/infection: Quite often, a cervical smear test will show that the cells of the cervix are slightly irritated, which may be due to an infection. You may need further tests and treatment for the infection.

An abnormal cervical smear test result

About 8 per cent of routine cervical smear tests will indicate that a woman has abnormal cells that will require follow-up, and maybe treatment, to prevent cervical cancer. With minor abnormalities, more regular cervical smear tests may be all that is needed for a period of time. For many women, minor changes will return to normal.

By having more frequent cervical smear tests, as recommended by your doctor, it is possible to monitor and check the cervix and make sure the changes have not progressed any further. Your doctor will tell you whether or not you should have follow-up cervical smear tests to monitor abnormal cells or what further investigation or treatment may be appropriate.

If you need further investigations you will be referred for colposcopy. This is a way of examining the cervix, magnifying the surface so that it can be seen more clearly.

Leaflets entitled "What Your Abnormal Result Means", "The Colposcopy Examination" and "Your Smear Test" are produced by the Health Education Authority, The Cancer Research Campaign and the NHS Cervical Screening Programme.. Remember, cancer of the cervix can often be prevented.

Having a cervical smear test every three to five years is the best way of protecting yourself against cancer of the cervix. Check with your GP if you have any unusual symptoms, such as unexpected bleeding, even if you cervical smear test result was normal.

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