Why is cervical screening important?

Cervical screening can be a topic of discomfort or embarrassment for many women and people with a cervix. But the importance of the more commonly known ‘smear test’ is tenfold. There are many misconceptions and myths that can lead to missed invitations, which the government and health organisations alike have been addressing through public campaigns.

According to Cancer Research UK, there are around 3,200 new cases every year, yet 99.8% of cervical cancer deaths could be prevented.¹ In England, 69.9% of eligible individuals aged 25 to 64 were adequately screened in 2021-22, a 0.3% decrease on the previous year, when coverage was 70.2%.²

Jane Chalmers, Cancer Care nurse at AXA Health, explores why cervical screenings are so important and addresses what can deter some people from attending.

What is the test for?

There are many reasons why women and people with a cervix may not attend a screening, but one big misconception is that the test is for cancer - and this is not the case.

It’s a test to help prevent cancer. During the screening a small sample of cells will be taken from your cervix and tested for the human papillomavirus (HPV) which can cause changes to the cells of your cervix. These are called "high risk" types of HPV.

If these types of HPV are not found – you do not need any further tests.

If these types of HPV are found – the sample is then checked for any changes in the cells of your cervix. These can then be treated before they get a chance to turn into cervical cancer.

Finding these changes early means they can be monitored or treated, so they don’t get a chance to progress to cervical cancer.³

To put things into perspective, on average, out of every 100 people who have a cervical screening:

• 87 will have a negative HPV result,
• 13 people will have a positive HPV result,
• 9 will be invited for another screening in 12 months’ time and
• 4 will be referred to have a colposcopy (a procedure involving internal examination) by referral to a gynaecologist.⁴

We know that embarrassment and fear can cause many to put off going for a test, but it’s important you know what it’s for and what the results mean, so you can make your decision about going, armed with all the information you need.

What prevents people attending cervical screenings?

Embarrassment about the test

This is a common reason and completely understandable. You might think it’s undignified or worry about how you look ‘down there’, but the nurses really don’t give it any thought.

They know you might be feeling anxious and will do their best to calm your nerves and make the process as quick as possible. Jane says it’s helpful to remember that the nurse conducting your screening is likely to have gone through the screening themselves, so knows how you might be feeling.

The test itself only takes a matter of seconds, or minutes at most.

Fear of pain

This is a very normal reaction, however while some people may experience mild discomfort you definitely shouldn’t feel any pain.

If you do, tell the nurse. They may be able to make you more comfortable and can stop the procedure at any time if you wish. Throughout your test the nurse will explain what they’re doing so you’re aware of what’s going on.

It’s worth noting that any discomfort is short-lived and a small price to pay for the benefits of attending a screening.

Fear that the test will result in a cancer diagnosis

The test is designed to detect pre-cancerous cells, which could be early markers of cervical cancer. This means they can be treated or removed to prevent cancer developing.

It’s rare to find cervical cancer through screening. If you’ve never had a smear test and now worry that by going for one, you may be diagnosed with cancer, it’s important to remember that your risk is still relatively low.

According to Jo’s cervical cancer trust, it’s estimated that in the UK, a woman's lifetime risk of developing cervical cancer if she does not attend cervical screening (smear test) is 2%.⁵

It’s also treatable, with a survival rate of almost 9 in 10 (86.8%) people in England diagnosed with cervical cancer aged 15-44 surviving their disease for ten years or more.⁶

Access to screening and appointment times are inconvenient

Although convenient screening times might be more difficult in remote areas, it’s important to remember that if you can’t or don’t want to see a nurse in your local GP surgery, there are other places you can go.

These include some NHS walk-in centres and sexual health clinics. Search for these services by location on the NHS website.

The test can also be done privately through one of the larger healthcare providers or a local independent Wellwoman clinic, provided you meet eligibility criteria.

If you choose to go down the private route you’ll usually be seen more quickly and have more flexibility in terms of appointment times, but you’ll have to pay for the added convenience.

They don’t think they’re at risk

There are a number of misconceptions around whether or not cervical screening is necessary. Perhaps the biggest myth is that it’s just for women and people with a cervix who are sexually active, so if you’re a virgin, or you’ve stopped having sex, or you’ve only had sexual contact with another woman you don’t need to be tested. However, this is NOT the case!

The general rule is that everyone – women or transgender men – with a cervix, aged 25 to 64, are at risk of cervical cancer and should go for cervical screening when they’re invited.

There are usually only two valid reasons for not attending.

The first is if you’re pregnant – because it can make it difficult to interpret the results. If this is the case, tell your doctor or nurse why you can’t attend and arrange to have the test (or put a reminder on your calendar to make an appointment for one) 3 months after you give birth.

The second is if you’ve had a surgical procedure to remove your cervix, e.g., total hysterectomy or Manchester repair, so the test is unnecessary.

If you’ve had a hysterectomy for either early-stage cervical cancer, or persistent cell changes in the cervix, then something called a vaginal vault test will still be carried out. This is where a sample is taken from the top of the vagina and tested for HPV. It will be undertaken at a hospital and is used to help prevent any cell changes from developing into vaginal cancer.⁷

Top tips for cervical cancer screening

1. The best time to have the test is mid-cycle. It’s possible to have the test while menstruating but it can be harder to analyse the results – and the test may have to be repeated.
2. Remember you can ask for a female doctor or nurse to carry out the test. You may also choose to ask for a chaperone during the test or take a friend with you.
3. If you’ve experienced discomfort during a previous cervical screening test or have any particular concerns, let the nurse know so she can do what she can to make the procedure more comfortable. This may mean taking more time to talk you through the procedure and making sure you’re happy to go ahead, or using a smaller speculum, for example.
4. Relax – which may seem like a big ask but it is possible. Try focusing on a particular spot in the room and take long, deep breaths. The more relaxed you are, the less likely you’ll be to feel any discomfort and the sooner it’ll be over.
5. Think about what to wear ahead of your appointment. This probably isn’t an occasion for a jumpsuit or all-in-one, which will mean you getting pretty much naked from the off! A dress or long top that you can pull down immediately after the test can help you feel less exposed.

Finally, it’s worth bearing in mind that many experience a sense of empowerment after getting screened and feel compelled to protect and empower other women and people with a cervix. If you manage to get one reluctant friend to go for a cervical screening, you’ll have done an amazing thing for them.

References:

1. Cervical cancer statistics - Cancer Research UK
2. Cervical Screening Programme, England - 2021-2022 - NHS
3. What is cervical screening? - NHS
4. Cervical screening: helping you decide – Gov.UK
5. Risks and causes of cervical cancer – Jo’s cervical cancer trust
6. Cervical cancer statistics - Cancer Research UK
7. Smear tests after a hysterectomy: what is a vault smear? – Jo’s cervical cancer trust