Understanding cervical cancer symptoms and having a regular smear test is so important as this disease is avoidable and highly treatable, says Dr Melanie Wynne-Jones
Cervical cancer (cancer of the neck of the womb) affects over 3,100 women a year in the UK – three-quarters of whom are in mid-life. But older women get it too, and numbers are increasing.
It’s now the most common cancer in women under 35. Pre-cancerous abnormalities are detectable long before symptoms appear, and can be treated to prevent cancer from developing, but worryingly – UK screening rates are falling. More than a fifth of women eligible for the test haven’t been tested in the past five years.
What causes cervical cancer?
The main cause of cervical cancer is HPV (human papilloma virus) infection, which alters cervical cells and can be passed on during lovemaking (it’s also linked to cancers of the mouth and anus).
Around 86% of schoolgirls are now immunised against the most virulent HPV strains, although this isn’t fully protective, so cervical screening in adulthood is still recommended.
Older women can opt for private immunisation (ask your GP about this). And many doctors believe teenage boys should be protected too, so they can’t pass the virus on.
Other links (not fully understood) include smoking, a family history of the condition, infections such as chlamydia or herpes, the oral contraceptive pill, working with tetrachloroethylene, and your number of partners and pregnancies.
Women who’ve have never had sex, or who have sex with women, should be tested too, but you don’t need screening if your cervix has been removed as part of a ‘total’ hysterectomy for non-cancerous causes.
What does the screening involve?
If you’re registered with a GP, you should receive a reminder, but ask if you’re overdue or not registered, and make sure you see your GP if you actually have symptoms (see tips box).
Book your test with your practice nurse or local sexual health or family planning clinic (see nhs.uk). You can ask for a chaperone or take someone with you.
The nurse will insert a plastic disposable instrument into your vagina so she can see your cervix (tell her if this feels uncomfortable, although a little discomfort is normal) and sweep it with a soft brush. This procedure has replaced the old ‘smear’ test and greatly reduced the need for repeat tests.
The brush is then put into a preservative and sent away for testing. You’ll receive your result by post within two weeks – ask if it doesn’t arrive. More than 90% of tests return with a ‘normal’ result.
Abnormal results and treatment
If either HPV or abnormal cells are detected, you’ll automatically be referred for an outpatient colposcopy which uses a magnifying telescope to identify abnormal areas on your cervix.
These can be treated or removed using laser or loop diathermy (a hot wire) and a local anaesthetic, and you’ll need follow-up checks.
Occasionally, a general anaesthetic is needed to remove more severe or widespread changes, but very few women have ‘high-grade’ abnormalities or actual cancer, or require extensive surgery or radio/chemotherapy.
How often should I be screened?
In England, you’ll be invited for a screening around your 25th birthday, then every three years until you’re 49, and every five years until you’re 64 (or after this if you’ve not been screened since you were 50).
But if you have an abnormal test or treatment, you’ll be screened more frequently until it’s clearly safe for you to transfer back to the normal programme.
Scotland, Wales and Ireland all have slightly different programmes, so make sure you ask at your surgery or visit cervicalscreeningwales.wales.nhs.uk, healthscotland.com or nidirect.gov.uk/cervical-cancer.
5 Cervical Cancer Symptoms You Mustn’t Ignore
1. Unusually heavy periods or unexpected/irregular vaginal bleeding between periods, after lovemaking or after the menopause.
2. A lump or persistent pain in your tummy or pelvis, including during lovemaking.
3. An unusual vaginal discharge (for example colour, smell, irritation and/or soreness).
4. Persistent or frequent tummy bloating, frequent urination, nausea and/or feeling full easily.
5. New or changing moles, lumps, ulceration, soreness, white patches or thickening on genital skin.