For the test, we need to sample some cells from your cervix,
which is at the top of your vagina. You will need to remove
your shoes, (trousers, tights) and pants and then lie on your
back on an examination couch. You will be asked to bend up your
knees, then the doctor or nurse who is taking the smear will
gently put an instrument, called a speculum, into your vagina
to part the vaginal walls so that your cervix can be seen. They
then gently scrape the surface of the cervix with a brush to
pick up some of the cells. These are transferred to a pot of
liquid and later sent to the laboratory for testing (eg in the
Department
of Cytology at Addenbrooke's).
Does the smear test hurt?
Most women would agree that the smear test is uncomfortable,
rather than actually painful. The speculum can feel a bit cold,
and you may be aware of a feeling of pressure while the cervix
is scraped. The more you are able to relax, the less uncomfortable
you will be.
I always find these examinations really difficult; do I have
to have the test?
The test is something you are offered to help protect your
health - it isn't compulsory. If you have ever had sexual intercourse,
it does make sense to have the test, because cervical cancer
is a rare consequence of some (papilloma) viral infections that
are caught during sex. The test is good at catching the early
signs of problems and can save lives.
If you are especially nervous, then please talk to us about
it. Some anxious women are helped by having a few 'practice
runs' before the actual test. This might involve getting to
know the doctor or nurse first. At another visit, they might
get onto the couch and get used to the idea of letting their
legs relax; the next time they might feel happy for a speculum
to be put into the vagina briefly but not actually opened; after
this they may feel they can cope with the test. Other women
find the whole thing much easier if they are helped to put the
speculum in themselves. Whatever it is you are concerned about,
please tell us. Remember, we are here to help.
How do I get the results?
Your results will be sent to you by post. They are usually
sent out about four weeks after the test, but it can take longer
when the laboratory is especially busy. If after eight weeks
you haven't heard, you can phone wherever you had the test for
your results (in case they got lost in the post). It is the
responsibility of the person who takes the test to inform you
of any abnormal result. To do this they must have an up-to-date
contact address for you. If further tests are advised by the
laboratory and they do not receive another test in the specified
time, they will contact the smear taker, who will contact you.
To do this, the smear taker must have an up-to-date address
for you.
What happens if the result shows something of concern?
Quite often women are re-called for another smear because of
problems with the test itself - for example the sample might
be contaminated or not have enough cells on it. Sometimes, the
test shows some borderline cause for concern and they want to
re-test to see if it has gone away. Sometimes, you will be sent
an appointment for a different type of test called a colposcopy.
In Cambridge, this takes place at the Colposcopy
Clinic, which is in the Outpatient Clinic in the Rosie Hospital
(on the Addenbrooke's site).
When should I arrange to have my smear test, and is there
anything I should avoid beforehand?
When you receive your invitation for testing, you need to work
out when you can be tested and arrange an appointment with your
doctor or family planning clinic at that time. The test can't
be done when you are having a period or for the few days before
or afterwards. This is because period blood cells can hide the
cervical cells. You should try to make your appointment for
about half way between your periods. During the 24 hours before
your test, you should not use a spermicide or sexual lubricant
because the chemicals in these can affect the result.
How reliable is the test?
It is believed that early detection and treatment of pre-cancerous
cells in the cervix can prevent 80 to 90% of cervical cancers
developing. However, it might not always be possible to detect
early cell changes that might eventually lead to cancer.
If my last test was negative (OK), does this mean I will be
OK?
Women can develop problems after having several negative smear
tests. Between smear tests, if you have any unusual symptoms,
such as bleeding after sex, or bleeding between periods or bleeding
after your menopause, you should seek advice from your GP. Unusual
bleeding can be a sign of several gynaecological problems including
endometrial (womb) cancer, which is not detected by smear tests.
What happens if the test shows abnormalities?
Abnormalities are 'concerns' but this doesn't mean you have
cancer. When we do a smear test, we are collecting some cells
to look at under the microscope. If the cells look abnormal
('odd') it can mean they are turning into cancer cells but abnormal
cells can stay looking 'a bit odd' for some time or go back
to looking normal again. Recommendations for further tests or
treatment depend on how abnormal the cells appear. If the abnormalities
are quite minor, then you will just be asked to have another
smear test in a few months. You will be kept under this 'extra'
checking regime for a few years. If the cells look more abnormal,
you will be offered other tests and treatment, which will be
explained to you in detail.
Do I have to have the extra tests?
It is really important that you attend for any extra tests
offered to you after your smear test. They can protect your
health and stop you worrying about 'what might be'. Many minor
abnormalities disappear during this period of observation. Some,
however, progress to become more severe, and some are more abnormal
at the time of the initial smear. If the testing laboratory
and your doctors have any concerns, you will be offered an appointment
at the colposcopy clinic (eg at
the Rosie Hospital for Cambridge).
If I am called for a repeat test, does it mean I have abnormal
cells?
About one in ten smear tests have to be repeated because the
laboratory couldn't see enough cells to give a reliable opinion
(called an inadequate smear). The National Programme aims to
train its staff well and checks how well the system performs
but problems and accidents happen including:
-
You have an infection, which might need treatment.
-
(Normal) blood or mucus hide the cervical cells.
-
Not enough cells were collected on the slide
-
Something went wrong with the preparation of your slide
including it getting lost or broken.
Who is least, and most likely, to develop cervical cancer?
Any woman can develop cervical cancer. The kind of pre-cancer
that is normally detected by the smear test does not occur in
women who have never had sexual intercourse, although other
kinds of cervical cancer can happen in these women. Abnormal
smear tests are more common in the following groups of women:
-
Those who first had sex at a young age (eg under 18 years);
-
Those who smoke;
-
Those who don't use condoms or caps;
-
Those who have had several sexual partners;
-
Those whose partners have had several other sexual partners;
-
Those who take immunosuppressant drugs (for example, after
an organ transplant) and those who need long-term steroid
treatment for any reason.
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