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Cervical cancer screening

Cervical screening is very important because we can stop cervical cancer from developing. This is one of the few cancers that is preventable because abnormal cell changes can be picked up before they have a chance to develop into cancer.

The screening test involves a nurse or doctor taking a small sample of cells from the surface of your cervix. They do this by putting an instrument called a speculum inside your vagina and then scraping the cervix with a small soft brush. The doctor or nurse rinses the brush in a pot of liquid, or removes the head of the brush and leaves it in the liquid. They then send the sample to the laboratory.

Who is screened?

If you are between the ages of 25 and 64, the NHS cervical screening programme will contact you every 3 to 5 years (depending on your age) and ask you to go for a cervical screening test. At the moment, the age that screening starts and finishes is slightly different in Scotland. But they plan on changing their screening ages to be in line with the rest of the UK in 2015.

Screening test results

The screening test picks up abnormal cell changes. This does NOT mean that you have cervical cancer. But if these abnormal cells were left untreated they may develop into cervical cancer in the future.
 

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Why we need screening

Cervical screening is very important because we can stop cervical cancer from developing in the first place. This is one of the few cancers that is preventable because abnormal cell changes can be picked up before they have a chance to develop into a cancer.

 

What the test is

The screening test involves a nurse or doctor taking a small sample of cells from the surface of your cervix. They do this by putting an instrument called a speculum inside your vagina and then scraping the cervix with a small soft brush. The doctor or nurse either rinses the brush in a pot of liquid, or removes the head of the brush and leaves it in the liquid. They then send the sample to the laboratory. This is called liquid based cytology. In the lab, a pathologist puts your sample under a microscope. They examine the cells and report any abnormal ones.

 

Who has screening?

If you are between the ages of 25 and 64, the NHS cervical screening programme will contact you every 3 to 5 years and ask you to go for a cervical screening test. Currently, the exact age groups for screening vary slightly between Scotland and the rest of the United Kingdom.

In England, Wales and Northern Ireland, women between the ages of 25 and 64 are screened. Between the ages of 25 and 49 you have screening every 3 years. Between 50 and 64 years you have screening every 5 years.

In Scotland, women between 20 and 60 years are invited for screening every 3 years. 

We know from research that cervical cancer is very rare before the age of 25. But changes in the cervix are quite common in younger women. So screening younger women can lead to unnecessary treatment and worry. Following recommendations from the UK National Screening Committee in 2012, Scotland plan to raise the screening age to 25. They will also extend screening for women up to the age of 64. This is due to start in 2015.

Make sure that you begin having regular cervical screening as soon as you are 25 if you are sexually active. If you are under 25 and are at all concerned about screening or have any symptoms, talk to your GP or go to a well woman clinic.

If you are 65 or over and have never had a cervical screening test you can ask to have one.

 

Why the screening interval varies

The screening interval is the time between the screening tests. This used to vary between health authorities. But research reported in 2003 by Cancer Research UK showed that the screening interval should be decided by age. We can pick up the most cancers by screening women every 3 years if they are 25 to 49 years old and every 5 years if they are between 50 and 64. 

For women between 25 and 49, 3 yearly screening prevents 84 cervical cancers out of every 100 (84%) that would develop without screening. 5 yearly screening will only prevent 73 cancers out of 100 (73%). So guidelines recommend screening women 3 yearly if they are under 50.

It is acceptable and safe for women of 50 or more to have 5 yearly smears. Screening 3 yearly doesn't give any extra protection for this age group.

 

Where you can have the test

You can have a cervical screening test at

  • Your GP surgery
  • A well woman clinic
  • A family planning clinic
  • A genito urinary clinic (clinic for problems with the genital or urinary organs)
  • An antenatal clinic if you are pregnant
  • A private health clinic
  • A voluntary organisation clinic, such as Marie Stopes

You can ask for a female nurse or doctor to do your cervical screening test. All clinics will have women available to chaperone a male doctor. But if you only want a woman to do the test, you may have to make an appointment to go back at a later date. So if you are concerned about this, it is best to mention it when you first make your appointment.

Remember that you should try to make your screening appointment for the middle of your menstrual cycle if possible. In other words, between periods. It is more difficult for your doctor or nurse to see the cervix and take a sample of cells if you have your period when you go. You may get an inadequate result and have to go back for another test.

 

How you have the test

You take off your underwear and lie on your back on a couch. You have to lie with your knees drawn up and spread apart. If this position is difficult for you to get into, you can ask your nurse to take the test when you are lying on your side with your knees drawn up.

To take the sample of cells, the doctor or nurse puts an instrument called a speculum inside your vagina. This may be a little uncomfortable but it shouldn't hurt. It can be more uncomfortable if you are very tense. Try to relax. Taking a few deep breaths can help. 

The speculum has 2 arms that spread the sides of your vagina apart so that the doctor or nurse can see the cervix clearly. Then they scrape the surface of your cervix with a small soft brush. This collects a sample of cells from the outer layer of the cervix. As soon as the doctor or nurse takes the sample, they will put it into a pot of liquid. This is then sent to the laboratory. The speculum is gently removed. Then the test is over and you can get down from the couch.

 

How you get the results

The lab will automatically send the results back to the surgery or clinic where you had the test. Your surgery may not contact you if the test is normal. But they should if there is anything wrong, or if the test could not be read properly for some reason. Just to make sure, it is best to contact your GP or clinic for your own result. Ask them when the results should be back. Then you can ring if you haven't heard.

In some areas, you will get a letter directly from the hospital with the result, and an appointment for the colposcopy clinic if necessary. The letter will usually include a small booklet to explain more about what an abnormal result means.

 

What the results mean

There are several different results you can have after a screening test. Some of the results are due to problems with the test rather than because there are any abnormal cells. You could be told you need a repeat test because yours could not be read properly (sometimes called having an inadequate sample). This could be because

  • There were not enough cells in the sample
  • You have an infection which meant the cells could not be seen clearly enough
  • You were having a period and there is too much blood to see the cells clearly
  • The cervix was inflamed and so the cells could not be seen clearly enough

In all these cases, you will just be asked to go back and have another test. This is usually about 3 months later. If you have an infection, you will have some treatment first.

Although most women will have normal results, it's not uncommon to have an abnormal result. This happens in around 1 in 20 women (5%). An abnormal result means that there are some changes to the cells on the cervix. Many of these changes will go back to normal by themselves. But in some cases, if left untreated, these changes could develop into cancer in the future. 

It is very rare for an abnormal result to show that a cancer has already developed, especially if you have been having regular screening. But this is possible.

 

Cervical erosion

Cervical erosion is a condition often picked up by cervical screening tests. You may hear it called an ectropion. It has nothing to do with cervical cancer. It means that glandular cells, which are only normally seen inside the cervical canal, can be seen on the surface of the cervix. The cervix often looks a little inflamed in this area. An erosion is nothing to worry about. It is common in teenagers, in pregnancy, and in women on the pill. It can cause slight bleeding, especially after sex. Usually the condition goes away by itself without any treatment.

 

Abnormal test results

Abnormal results can be reported in 2 different ways. In the UK, if you have abnormal cells you are most likely to be told you have

  • Borderline or mild cell changes (low grade dyskaryosis)
  • Moderate or severe cell changes (high grade dyskaryosis)

More rarely your screening test result may say CIN 1, CIN 2, or CIN 3 instead of mild, moderate or severe. CIN stands for cervical intraepithelial neoplasia. This just means cervical cell changes. This classification is not strictly accurate as CIN can only really be diagnosed with a biopsy. But these results do indicate that you probably have

  • CIN 1 if you have mild cell changes
  • CIN 2 if you have moderate cell changes
  • CIN 3 if you have severe cell changes

The 3 grades of CIN relate to the thickness of the skin covering the cervix that is affected. CIN 1 means up to one third of the thickness of the skin covering the cervix has abnormal cells. CIN 2 means between one third and two thirds of the skin covering the cervix has abnormal cells. CIN 3 means the full thickness of the skin covering the cervix has abnormal cells. Both the level of cell abnormality (mild, moderate or severe) and the CIN level will be taken into account when deciding whether you need treatment.

All these results mean that cells have been found on your test that have abnormal changes. This does not mean you have cervical cancer. It means that some of the cells are slightly abnormal and if they are left untreated, they could go on to develop into cervical cancer.

Remember that we are talking about the test as screening for cervical cancer here. Screening means testing healthy women. If you have symptoms of cervical cancer, you may have a liquid based cytology test as part of the tests used to investigate your symptoms. This is a very different situation to having the test as a routine screening test. If you have any symptoms, you should talk to your GP.

 

Mild cell changes

Currently, what happens if you have borderline or mild cell changes (low grade dyskaryosis) varies depending on if you live in

England and Northern Ireland

If you have borderline or mild cell changes, the laboratory will test your sample for the human papilloma virus (HPV). Certain types of this virus increase the risk of cervical cancer. If there is no HPV (HPV negative), the cell changes are likely to go back to normal or stay the same. So you will go back to the routine screening programme of having tests every 3 to 5 years.

If you have a high risk type of HPV, you will be invited for colposcopy to see if you need treatment for the abnormal cells.

Scotland and Wales

If you have borderline or mild cell changes, your doctor or nurse will either suggest a colposcopy straight away or ask you to go back for another screening test in 6 months time. Sometimes these slightly abnormal cells can go back to normal by themselves. But you should definitely go for your repeat test. You can't assume that the cells will go back to normal. If your next test is normal you may have 2 further tests, 6 months apart, before returning to regular screening every 3 to 5 years. If your repeat test is abnormal, you will then have a colposcopy to check it out further. You may need some treatment.

 

Moderate or severe cell changes

If you have moderate or severe cell changes (high grade dyskaryosis), you will be referred to colposcopy straight away. Your doctor or specialist nurse will take a sample of cells (biopsy) from the abnormal area. They may ask you to go back for treatment depending on the result of the biopsy. Or in some clinics, they may offer you treatment at the same time as the colposcopy. There is information about treatment for abnormal cervical cells in this section.

You usually only need treatment once. Then you have follow up tests. If you have an abnormal test and have successful treatment you are very unlikely to get cervical cancer if you continue having screening. If you do not have treatment, you are very much at risk of developing cervical cancer in the future.

 

Carcinoma in situ (CIS)

CIN 3 is sometimes called carcinoma in situ. This sounds like cancer, but it isn't. It means that some of the cells look cancerous. But they are all contained within the skin layer covering the cervix. It will not be a true cancer until the cells break through the layer covering the cervix and spread into the tissue underneath. You must have treatment as soon as possible if you have carcinoma in situ. As long as the affected area is removed, cancer can be prevented.

 

How reliable the test is

You may have heard various news reports in the past about women being recalled for cervical screening tests because the system went wrong. And even about some women dying from cervical cancer because their tests were not checked properly and so they missed out on the treatment they needed. But this is very, very rare. As a result of these very rare mistakes, the screening system has been tightened up even further.

Two trained technicians now check all cervical screening tests. The abnormal cells that were missed in the past were all in health authorities who didn't make sure two people checked their samples. And in some cases because technicians were not trained or supervised properly. So you can feel reassured that if there are abnormal cells in your screening test they are highly likely to be found and treated so that they cannot develop into a cancer.

Lastly, always make sure you get your result. If you do not get the result, there is always the tiny chance that the test was reported as abnormal but that this result was not sent back to you or your GP.

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Updated: 2 August 2014