How to spot the warning signs of gynaecological cancer
Smear test myths you need to stop believing
For the first time ever, Public Health England has launched a national campaign aimed at inspiring women to attend their cervical screening when they're invited, or make an appointment if they've been invited in the past and haven't gone.
Why cervical cancer? Why now? Because cervical screening stops cancer from happening. Because cervical screening saves lives. Because two women die every day in England alone from cervical cancer, and because screening rates are at a 20-year low and dropping. Of the 4.46 million women invited for screening in 2017 and 2018, only 3.18 million took up the invitation.
If you're one of the missing millions, there's a good chance that one of the many myths around cervical screening put you off. Here's what women said, and here's the truth:
I'm not sure screening really works
Since the NHS cervical screening programme was introduced in the UK in 1988, death rates from cervical cancer have dropped by 70%, and it's estimated it saves 5,000 lives a year across the UK. Next, please!
There's a vaccine now which stops cervical cancer
Virtually all cases of cervical cancer are indeed due to a virus called HPV, and in particular two 'high-risk' strains (16 and 18) responsible for about 70% of cases.
The HPV vaccine targets these strains, and infection rates with strains 16 and 18 have dropped by 86% among 16- to 21-year-olds. But you won't have had it routinely if you're over 23, and even if you do have the vaccine, it's still important to attend for smears, because it won't prevent 100% of cases.
I'm too young to get cancer
All women are invited for screening from the age of 25. 25- to 29-year-olds are less likely than any other age group to take up their screening invitation, yet most likely to have an abnormality detected. In fact, 63% of all pre-cancers are found in women in this age group.
I'm terrified I'll find out I've got cancer - I'd rather not know
Most screening is about picking up cancers at an early stage, when they're more treatable and survival rates are much higher. But cervical screening goes one step further. It actually picks up pre-cancerous changes, which can be treated with virtually complete success - so it actually prevents you from getting cancer.
If you're scared to find out you've got cancer, you can actually stack the odds in your favour by having a smear.
Cervical cancer isn't a big deal - it's not like breast cancer, which is really common
Cervical cancer may not affect as many women in a lifetime as breast cancer, but it's the second most common cause of cancer in women under 35. In England, around 2,600 women are diagnosed with cervical cancer and 690 die from it each year.
Yet it's eminently preventable - it's estimated that because most cancers take years to develop, 83% of cases could be avoided if everyone had a smear whenever they were invited.
It's so embarrassing
Your nurse or doctor will have performed hundreds (or possibly thousands, as in my case - don't ask how long I've been a doctor!) of smears. For them, it's not remotely awkward. In fact, it's a positive part of their day, because they know they could be making a real difference.
If you'd rather have a female smear-taker, that can be arranged. You hop up on the couch, hidden behind a screen, and the procedure is over in minutes. Let your smear-taker know if you want them to tell you what they're doing at every step - women have very different views on this.
I've carried out more smears than I care to remember, and had my fair share. They're a bit uncomfortable for a couple of minutes, but they definitely shouldn't be painful.
If you're anxious, it can make you tense up more: let your smear taker know if you're feeling a bit nervous, and she'll stop immediately if you're uncomfortable. Smears are often more uncomfortable after the menopause, when vaginal dryness becomes an issue. Give your GP a ring a few weeks before you attend; they can prescribe oestrogen cream to help make the vaginal tissues more springy.
I don't need a smear if I'm gay
Wrong, wrong and wrong! This is one of the most worrying myths about cervical screening - LGBT people who are called for cervical screening are up to ten times less likely to attend than straight women. Yet HPV isn't fussy - it can be passed on by any intimate contact, not just heterosexual vaginal sex.
I've had normal smears for 30 years - I'm not going to get cancer now
Women over 50 are more likely than any other age group to have regular smears, but take-up rates are dropping in this age group too. More than one in three cervical cancers occur in women over 50, and those who are diagnosed are more likely to have advanced stage cancer.
You've prioritised your health until now. Please don't stop until we tell you it's safe to stop!
If I develop signs of cancer, I can always go then
By the time you develop signs of cervical cancer, it's likely to be more advanced and any treatment you have may need to be more extensive. You're far better off having changes picked up at an early stage, where minor treatment (often done within minutes in an outpatient clinic) can solve the issue.
But if you do develop bleeding between periods or after the menopause, or before or during sex, do see your doctor.