How to get over smear test fear
We've all done it - picked up a letter from the doormat and promised ourselves we'll get around to dealing with it. But all too many of us put off replying to those secretly unwanted letters until the 'due date' has passed. Here's where I get to make myself really unpopular by stating the obvious - health screening is designed to save your life.
It may not be fun - but if it wasn't worth it, the NHS wouldn't recommend it. Yet every year I get hundreds of notifications of 'DNAs' - Did Not Attends.
Cervical screening (going for regular cervical smears) is enormously important to reduce your risk of getting cancer of the cervix (the neck of the womb). The UK is a world leader in cervical screening, and it shows. To put it into perspective: in the first ten years after the national programme for cervical screening was introduced in the UK in 1988, the number of women who developed cervical cancer fell by a spectacular 42%. And since the early 1990s, the incidence has fallen by a further 24%.
Without screening, cervical cancer is a killer. But as you get older, your chances drop, and by the age of 65, you won't need smear tests anymore. Who said getting older was all bad news?
What causes cervical cancer?
Virtually all cervical cancers are caused by infection with a virus called HPV. There are several different kinds, but only a few are linked to cancer. HPV is so common that getting infected is more a rite of passage than a sign you've been promiscuous. Key times to be exposed are in your late teens or early 20s.
Most women's immune systems fight off the infection within months. But in some, it stays in the body, and can lead to cancer many years later. Peak incidence for diagnosis is in the 25- to 29-year age group. But some women find love second time around after decades of monogamy, and the time it takes for HPV to lead to cancerous changes varies widely. So it's still important to continue to attend for your cervical smear when invited, even if you've had the same partner for years.
The HPV vaccine
The well-proven link between HPV and cervical cancer is why since 2008, all 12-year-old girls in the UK have been offered immunisation against several high-risk strains of HPV. The evidence is that it's most effective if it's given at this age, before you're sexually active. It's not 100% effective, and it's going to take a few more years before the full benefits are seen. Most women are diagnosed in their 30s or early 40s, and it's rare under 25. We will still need a cervical smear programme - but hopefully the number of women with an abnormal smear (currently about 1 in 20) will start dropping dramatically.
A special screening case
Most health screening - for high blood pressure, breast cancer, raised cholesterol, etc - aims to pick up a problem before it causes complications. The national breast cancer mammography and FOB testing for bowel cancer are both designed to pick up early-stage cancers which have a better chance of being successfully treated.
But cervical screening goes one better. The cells on the surface of the cervix - some of which are removed and examined during a cervical smear - go through several early changes before they become cancerous. These pre-cancerous changes can be picked up with a cervical smear and treated to ensure they never cause cancer. Even better, all cervical smear samples in the UK are now pre-screened for evidence of high-risk HPV. This means that women with no evidence of high-risk HPV can be reassured, even if their smear test shows mild inflammation. And women with high-risk HPV infection can be targeted for closer surveillance, even if the cells from their smear test are normal.
Every woman in the UK is invited for a routine cervical smear every three years from the age of 25-49, and every five years from 50-64. Over-65s don't need testing unless they haven't been screened since they turned 50, or have recently had an abnormal result. The reason for less frequent screening after 50 is that unlike most health conditions, which have a horrible habit of getting more common with age, your risk of cervical cancer drops with age.
Cervical screening has been a huge success story in the UK. Sadly, however, there's no room for complacency. It's probably no coincidence that the proportion of younger (under 50) women taking up their screening invitation started rising just after Jade Goody's diagnosis in 2008, and stayed at about 74% until about 2012. Levels have been dropping since then, and in 2016 only 71.3% of women were screened. Over-50s have always been better about attending for screening, but rates have been dropping for a decade. Today 1 in 4 women over 50 doesn't take up her invitation.
Yet cervical screening can prevent many cases of cervical cancer, and predict many more so evasive action can be taken. They're free, and the only cost to you is 10 minutes of your time.
Know the warning signs
Cervical screening isn't the whole answer. Most cervical cancers start fairly slowly and can be picked up at screening. But some are very aggressive and can develop between smears. Cervical smears also aren't 100% accurate, although recent changes to include high-risk HPV screening have helped. So if you get bleeding between periods, after you make love or after the menopause, pain when you make love or an unpleasant smelling discharge, you should always get it checked out.
If you are diagnosed with cervical cancer, treatment depends on how far advanced it is. 8-9 out of 10 women can be cured if the cancer is picked up before it has spread. There is, however, new hope even in advanced cancer. A new study with a medication called nivolumab, which targets the immune system, showed that 1 in 4 women with advanced cancer responded to treatment. Early days, but exciting news.
Thanks to My Weekly where this piece was originally published