It is important to understand that cervical screening is not a test for cancer. It is a method of preventing cancer by detecting and treating early abnormalities on the cervix. If these abnormalities are left undetected, they can lead to cancer of the cervix (neck of the womb) in the future.
Early detection and treatment of the cervical abnormalities can prevent 75% of cancers of the cervix but like all other screening tests, it is not 100% perfect. This is due to the fact that sometimes all of the cells are not available or visible at the time of the screening test. This screening test is carried out by taking a smear from the neck of the womb on a slide which is called a smear test or on a liquid media called LBC (liquid based cytology). The smear test is not painful, but may be slightly uncomfortable.
The smear test is done by inserting a speculum in the vagina. The speculum size may vary depending on the size of the woman. The speculum opens the vagina and a spatula or a soft brush is used to remove cells from the cervix.
The sample is taken on a slide or a liquid media which is called LBC and is sent to a laboratory. The latter procedure is more accurate and the false negative results are much less than with a smear test. The other advantage of having a liquid based cytology is to check the presence of high-risk human papilloma which is linked with cervical cancer.
The age for screening via the NHS commences at 25 by invitation. Thereafter between the years of 25 to 49 it is every three years and from 50 to 64 it is every five years.
Younger women who are sexually active from a much earlier age ie during teenage years, could still have cervical abnormalities and an earlier smear/screening test would be advisable. Currently a screening test is not available before the age of 25 via the NHS, but it is available earlier in the private sector.
Women who are not sexually or have never been sexually active have a much lower risk than women who are sexual active. For these women it is not compulsory and a woman may choose to decline. Accepting an invitation for cervical screening for women who are not sexually active is important, as cases have been reported in women who are not sexually active.
It is important to know why the screening test is important for cervical cancer. There were an estimated 4,200 new cases of invasive cancer in England in 2000. After the cervical cancer screening programme was introduced, the incidents fell by 42% from 1988 and 1997 (England and Wales). This fall is directly related to the cervical screening programme. Cervical screening saves around 4,500 lives every year in England. In 1999 21,617 women in England were found to have the most severe type of pre-cancerous lesions called CIN3.
This can only be detected with screening and is treated in order to prevent invasive cancer developing. An estimated 471,000 new cases of cervical cancer are diagnosed each year in the World with 80% of these occurring in the less developed World. Cervical cancer is the 11th most common cause of cancer in women in the UK compared with Third World countries where it is one of the most common killers. The latest relative cervical cancer figures for England show that an average of 84% of women diagnosed with cervical cancer between 1993 and 1995 were still living one year later and 66% were alive 5 years later.
In summary it is important to say that cervical screening is very important in order to prevent cervical cancer by diagnosing pre-cancerous cells in the lesions and treating them.
The risk factors for cervical cancer
The exact cause is not known, but it is important to know that certain types of human papilloma virus HPV are linked to around 97% of all cases of cervical cancer.
Women with many sexual partners whose partner has also had many partners, are at more risk of developing cervical cancer.
Using a condom has some protection, whilst long term use of the oral contraceptive pill can increase one’s risk of cancer.
Women who smoke are twice as likely to develop cervical cancer as non smokers.
Women in manual social classes are at a higher risk than non-manual social classes.
Women who take immunosuppresent drugs (for example after kidney transplant) are at risk of cervical cancer.