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Cervical screeningPublished by Bupa's health information team, July 2006. This factsheet is for women who would like information about cervical screening. Cervical screening helps detect changes in the cervix. It checks for cells that may, if untreated, develop into cervical cancer. Catching the changes early means cervical cancer can be prevented from developing. For more information about cervical cancer, please see the separate Bupa factsheet, Cervical cancer.
The cervixThe cervix is the neck of the womb. It is located at the top of the vagina. ScreeningThe cervical screening programme helps detect changes in the cells of the cervix at a pre-cancerous stage. The changes can be detected by a laboratory test on a small sample of cells from the surface of the cervix. This test is often called a smear or pap test. Why screen for cervical cancer?In 2003, around 2300 women were diagnosed with cervical cancer in England. Many of the women who develop cervical cancer have never been screened. The greatest risk factor for cervical cancer now is failing to go for regular screening tests. Who should be screened?The Department of Health (DoH) advises that women have their first screening test at 25 and then every three years until they are 49 and five yearly until they are 64. Cervical cancer is very rare in women under 25, and screening is stopped once a woman reaches 64 because she is very unlikely to then develop cervical cancer. However, anyone over 64 who has ever had abnormal screening results will be invited for screening in the normal way as will women who have not had a screening test since they were 50. When is the best time to be screened?The best time to be screened is 14 days after your last period. You cannot be screened during your period. Can I be screened when pregnant?It is not normally recommended that you have a screening test if you are pregnant. Usually women wait until three months after delivery to have a test. This may depend on your history of screening results however, ask your GP for more advice. About the screening testA screening test is usually done by a practice nurse or GP. The procedure usually takes about five minutes. Most women find it a little uncomfortable, but not painful. You will be asked to lie on your back on a couch, with your legs drawn up and knees apart. An instrument called a speculum will be used to gently open your vagina so your doctor or nurse can see your cervix. The cell sample will be taken with a plastic cervical broom and the cells will be placed in liquid. This procedure is called liquid based cytology (LBC). Alternatively, the cell sample will be taken with a wooden spatula or an "endocervical brush" and the cells will be placed on a slide. Cells are taken from what is called the transformation zone. This is where the lining of the inner surface of your cervix meets the lining of the outer part of your cervix. The sample will be sent to a laboratory to be examined by a pathologist who will look for abnormal cells.
Screening resultsAlthough the results of most tests are normal, around one in ten women have an abnormal result at some point in their life. It is important to remember that an abnormal screening result does not mean that you have cervical cancer. A "borderline" result means that minor cell changes were seen, but will probably go back to normal on their own. You will need to have a repeat screening test, usually in six months. You will not need any treatment unless the changes get worse. An abnormal result usually means that small changes have been found. The abnormal sample is called dyskaryosis. A colposcopy is usually the next step (see Colposcopy). Sometimes the result may be "inadequate" or "unsatisfactory" because the sample taken did not have enough cells or you have a slight infection. If this happens, you will need to have another screening test. If you have an infection, you may need to get it treated first. Risk factorsThere are a number of risk factors that make an abnormal result more likely. For more information about these, please see the separate Bupa factsheet, Cervical cancer. ColposcopyYou may need to see a gynaecologist (doctor specialising in the female reproductive system) as an outpatient in a hospital to have a colposcopy. Alternatively, a specially trained nurse or your GP may perform the test. As with the screening test, you will be asked to lie on your back on a couch, with your legs drawn up and knees apart. A speculum will be used to gently open your vagina and a solution of acetic acid (the acid in vinegar) will be gently wiped onto your cervix. This stains any abnormal cells white. Your doctor or nurse will examine your cervix closely through a binocular microscope called a colposcope. If abnormal areas are seen on your cervix, tiny samples may be taken and examined in a laboratory (a biopsy). If the biopsy confirms the dyskaryosis detected in a screening test, this may be termed cervical intraepithelial neoplasia (CIN), which is just another way of saying cervical cell changes. Doctors may also talk about CIN when the results are received. CIN is not cervical cancer, but an early warning stage. It is graded one to three depending on how deep into the lining of the cervix it penetrates.
In many cases of CIN 1, cells return to normal on their own. With CIN 2 and CIN 3 there is more risk of progression to cervical cancer. But only a proportion of even the most severe cases of CIN will become cervical cancer, and this may take around 10 years. Sometimes CIN 3 is called carcinoma in situ (CIS). This means that the biopsy showed that the cells were cancerous, but were all contained within the lining of the cervix. Cancer can still be prevented if the affected area is removed. You will not be diagnosed with cancer itself unless the cells break through the bottom layer of your cervix's lining into the tissue beneath. TreatmentThere are a number of treatments for abnormal cells. Most of these treatments take place at an out-patient appointment in a colposcopy clinic. The procedures are done under local anaesthetic that numbs the area but you will be awake. Other treatments require an overnight stay in hospital and use general anaesthetic, which means that you will be asleep throughout the procedure and will feel no pain. LLETZ or loop diathermyIn a LLETZ (large loop excision of the transformation zone) procedure, a loop of wire that is heated by an electric current will be used to remove the abnormal cells. The cells are not destroyed so the tissue can be sent to a laboratory for testing. Laser therapyLaser therapy (also known as laser ablation) uses heat to destroy the abnormal cells. A laser beam will be pointed at the abnormal area which burns away the abnormal area. Cold coagulationUnlike the name suggests, cold coagulation also uses heat to destroy abnormal cells. A hot probe will be used to burn away the abnormal cells. CryotherapyCryotherapy involves using a probe to freeze the abnormal area to destroy the cells. Cone biopsyThis minor operation removes the whole area where there might be abnormal cells. You may have cone biopsy under general or local anaesthetic and may need an overnight stay in hospital. HysterectomyThis is a major operation in which the cervix and womb are removed. It is rare for a doctor to recommend a hysterectomy for CIN. It is usually only considered if you are past the menopause, have had all the children you want or have been diagnosed with invasive cervical cancer. Ask your doctor or nurse for more information on these treatments. Follow upAfter treatment, you should be screened every year. A follow up colposcopy is sometimes required also. The number of yearly screening tests you should have will depend on how abnormal your cells were and whether they were completely removed. Ask your doctor or nurse for more advice.
Further information
Sources
Publication date: July 2006
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