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DR. DAWN HARPER CERVICAL CANCER & THE SMEAR TEST

DR. DAWN HARPER | CERVICAL CANCER & THE SMEAR TEST


CERVICAL CANCER & THE SMEAR TEST Cervical cancer usually develops slowly over the several years, which is why regular cervical screening is essential to detect changes early and prevent it occurring. However, around 3,000 women are still diagnosed with cervical cancer every year.

TYPES OF CERVICAL CANCER There are two types of cervical cancer: Squamous cell carcinoma Ths is by far the most common form, and is due to cancerous changes in the flat cells that cover the outer surface of the cervix. Adenocarcinoma A rarer form of cancer that starts in the glandular cells lining the inside of the neck of the uterus. It can be more difficult to detect with smear tests.

WHAT ARE THE SYMPTOMS?

WHAT IS THE HPV VACCINE?

Most women with cervical cancer will not have any symptoms until the disease is quite advanced this is another reason why it is so important to attend your smears when you are called. Cervical cancer can cause abnormal bleeding so if you have any bleeding between your periods, you should see your doctor to rule out this possibility. However, most cancers of the cervix are picked up on routine smear tests before any symptoms are present.

Cervical cancer is linked to infection with two particular strains of human papilloma virus, types 16 and 18. The HPV vaccine protects against these strains and is 99% effective at preventing changes in the cervix associated with this infection. It is routinely offered to girls aged 12 – 13 as it is most effective if given before a girl becomes sexually active. WHAT IS THE TREATMENT? Treatment depends on how early the disease is diagnosed, and can involve any combination of radiotherapy, chemotherapy and surgery.

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Early stage cervical cancer has an excellent outlook, with 85% of women making a full recovery, but sadly more advanced disease that has spread beyond the cervix doesn’t have such a good outlook - around 1,000 women in Britain still die of the disease each year. THE CERVICAL SMEAR Smear tests look for changes in your cervix, which if left untreated could progress to cancer over a period of years. So having a regular smear test can prevent you from developing the cancer. It may not be your idea of a fun day out, but it’s really worth having it done regularly. it’s estimated that cervical screening saves around 4,500 lives in England every year. HOW OFTEN SHOULD I HAVE A SMEAR?

were often reported as abnormal, necessitating followup smears. The majority of these changes settle, but being recalled for smear tests causes understandable angst, so it was decided to change the starting age for the screening programme. WHAT HAPPENS DURING A SMEAR TEST? When you attend your first smear test appointment, you will be asked about your periods and any hormones or other medication you may be taking. You will then be asked to undress from the waist down and lie on your back on an examining couch. The nurse or doctor will then ask you to bend your knees and relax your legs open. She will insert a small instrument called a speculum into your vagina, so that she can see the cervix. Using a plastic brush, she will wipe the cervix to collect some cells. These cells are then sent to the laboratory for analysis. The whole process will take around 10 minutes and isn’t painful.

QUESTIONS Q1

All women registered with a National Health Service doctor will be invited to attend the surgery for a smear test when they reach the age of 25. Provided everything is normal, you will be invited back every three years until you are 49. After 50, you will be invited every five years and, as long as your results stay normal, you will stop being called for smear tests after you are 65.

When is the best time to have a smear test and do I have to avoid sex beforehand? A smear test cannot be done during menstruation so I usually advise my patients to book mid-cycle. If you use a spermicide or lubricant or barrier method of contraception such as a condom, then you should not have sex for 24 hours before a smear.

Q2 The start point for cervical smears has recently changed in England. Previously, girls were recommended to have their first smear at the age of 21, and I am often asked if delaying it until 25 is safe. The decision was made because cervical cancer in girls under the age of 25 is exceptionally rare and women’s bodies and cervixes are still developing and changing in their early twenties. The changes noted on smears in the younger age group

I have just received the results of my smear test which says that the result is “inadequate” and that I must have a repeat smear in 3 months. Is this anything to worry about and why do I have to wait for 3 months? “Inadequate” smears are common. What this usually means is that either not enough cells were collected or it was difficult to interpret the results. Frequent causes are either bleeding or discharge. It is nothing to worry about but it is important to allow 3 months for the cells to recover.

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Q3

Q6

My daughter has had an “abnormal” smear. Her doctor says we shouldn’t worry and that it just needs repeating in six months. We are both desperately concerned.

If the changes persist, will I need treatment?

Don’t panic - we do over four million smear tests in Britain every year and more than 300,000 of those will be classified as “abnormal”. An abnormal smear test doesn’t necessarily mean cancer or even that it is likely to develop. The lab has simply found some changes in the cells which need to be monitored. The good news is that the majority return to normal within six months without the need for any treatment, which is why your GP has suggested your daughter come back for a repeat test then.

Q4 My recent smear test showed some abnormality which my doctor called “dysplasia”. What does this mean and does it need treating? In some ladies the cells on the cervix change from normal to abnormal and it is these abnormal cells which we call dysplasia. This is NOT cancer but the problem with dysplastic cells is that if left unmonitored they can sometimes become cancerous. There are 3 grades of dysplasia, mild, moderate and severe. Mild dysplasia will often return to normal without any treatment at all and generally we arrange to repeat the smear at 6 month intervals. If the abnormality persists or if the dysplasia is severe you will be given an appointment to have a colposcopy.

Q5 I have been referred for a colposcopy because of abnormal smears. What does this involve?

Treatment of cervical dysplasia depends on the severity. If only mild or moderate, then the area can often be removed under local anaesthetic in the colposcopy clinic and this takes 5 or 10 minutes. If the dysplasia is severe it may be necessary to remove a larger cone shaped are from the cervix – this is called a cone biopsy and is done under general anaesthetic. Q7 During a recent smear test, the doctor commented that I had an erosion on my cervix. What does this mean and will it need treating? The cells that line the inside of the womb are different to those on the outside and an erosion is where the more delicate cells that are normally inside the neck of the womb have migrated onto the outer surface of the cervix. This is very common, particularly in pregnant women or women on the oral contraceptive pill and usually causes no symptoms at all and requires no treatment. In some cases an erosion can cause bleeding between periods or after intercourse or an increased vaginal discharge. If this happens the erosion can be easily treated with freezing (cryotherapy) or an electrical current called diathermy or laser. The treatment doesn’t hurt and you might notice a vaginal discharge for a couple of weeks afterwards during which time it is best to avoid sex.

A colposcopy involves looking at the cervix with a special magnifying instrument. It is usually done in a hospital clinic and you will be asked to lie on a couch with your legs in padded stirrups. It doesn’t hurt and lasts about 15-30 minutes. The doctor will insert a speculum just like when you had your smear and will then look at the cervix through the colposcope. He/she may paint your cervix with different liquids to highlight the abnormal area and may then take a pinhead sized biopsy. This may be felt as a slight sting but nothing worse.

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Q8 Our daughter announced a few years ago that she is lesbian and I have just discovered that she has not been going for her smear tests. My sister died at 36 of cervical cancer so I am worried sick. Is it true that lesbians don’t need smears? 95% of cervical cancers are a type called squamous cell carcinomas, which are related to sexual activity, and this is the rationale for advising smear tests only in women who are or ever have been sexually active. The risk, if any, of purely gay sex in women is not known but if your daughter has ever had a sexual relationship with a man in the past she should certainly attend for her smears. D

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Cervical Cancer & Smear Test Factsheet