How often should women go for a smear test?

The NHS national screening programme says that “All women from the age of 25 to 64 should be tested every 3 years until the age of 49 and then every 5 years.”

Below the age of 20 cervical cancer is extremely rare.

If you are under 25 and have any concerns about your risks for developing cervical cancer or would like to discuss having a smear test then please make an appointment to see one of our GPs. For appointments call 0844 257 0346

Is there any need for any women to go more often than in the previous answer?

The smear test is to check the health of the cervix and to detect any abnormal changes in the cells which may possibly progress on to cervical cancer.
Cervical cancer is more common in women who smoke, first had sex at an early age, have had several sexual partners or a partner who has had had many partners.
It may be that women who fall into these categories may wish to have more frequent testing although cells will usually change at a very slow rate and so 3 yearly is adequate. Young women under 25 who started having sex at a very young age may wish to discuss this with their GP. If you have unusual bleeding or discharge you may require an earlier smear if other investigations are normal.


What is the link between HPV and cervical cancer?

The majority of people who have HPV infection will not develop cervical cancer.
The virus will simply go away on its own and not cause any abnormal cells to develop. Having a high risk type of HPV on the cervix does give you a higher chance of developing some mild abnormalities in the cells which may progress to more severe abnormalities and ultimately cancer if not treated.

In close to 100% of cervical cancers “high risk” types of HPV have been detected, (16, 18, (about 70%) but also 31, 33, 35, 39, 45, in much smaller numbers)


Should women with HPV be more concerned?

Women who are found to have high risk HPV types and abnormal cells on their cervix should be treated for the abnormal cells. Some women will have high risk types and no abnormal cells and so regular smear tests with HPV testing is very important to monitor any change. Those with high risk HPV do have a higher chance of developing abnormalities in the cells of their cervix.

The HPV vaccine is only available to school girls. Can you explain the reasons for this and do you think it's worth adult women paying for the vaccine?

HPV vaccine is licensed for girls and women aged 9-25 but can be given at the doctor’s discretion outside of these age limits.
The vaccine is most effective when given before the young woman becomes sexually active, and as such has not been exposed to any strains of HPV (which is transmitted sexually). It does not treat high risk HPV types once they are on the cervix. It has been found that younger women produce a better immune response to the vaccination than older women in general. This is another consideration for a national immunisation programme which has to be cost effective.
HPV is most common in young men and women who are in their early 20’s.
However most women will not have encountered both of the preventable high risk types, 16 and 18 which are in the vaccination and so there is an argument that it is beneficial to give the vaccine to older women also.
Testing for HPV can tell you whether you have types 16 and/or 18 currently which will help with the decision about vaccination.
One of the vaccines available also prevents infection with strains 6 and 11 which although classed as “low risk” are responsible for 90% of genital warts. These are not associated with the later development of cancer but can be very persistent and troublesome to treat.

A Catholic school in Manchester decided against allowing the HPV vaccination. Their reasons were that they don't want to 'encourage sexual promiscuity'. What's your take on this from a medical point of view?

HPV vaccination should be available to all women prior to their becoming sexually active as there has been found to be such a strong direct correlation with the later development of abnormal cells which may progress to cervical cancer.
Some would argue that giving rubella vaccination at the age of 12 or 13 to prevent abnormalities to a developing baby during pregnancy could be seen as encouraging early sexual activity!
The main information that should be given to young people is that condoms are an effective way of reducing exposure to sexually transmitted infections whether it is HPV, Chlamydia, Gonorrhoea or HIV.

What happens if you have an irregular smear?

An irregular smear may be one that shows cells with abnormal changes or simply a sample that has been insufficient to analyse. Only extremely rarely does it show cancerous cells.
You may be asked to return for a repeat smear test or be referred for a Colposcopy. This is an examination like a smear but with an instrument that acts like a microscope and gives a highly magnified view. It does not go inside you but is like a pair of binoculars. If you have HPV detected and abnormal cells you may require treatment to remove the abnormal cells at the Colposcopy.


And finally, women who aren't having regular smear tests or have never had a smear test might be fearful of the procedure. What is the process and what should they expect?

The smear test is carried out by a doctor or a nurse. You will be asked to remove your underwear but be given a sheet to cover your lower body. They will ask you to lie down on a couch and gently put a small instrument into the vagina to hold it open. They will then use a small brush to wipe over the cervix in order to pick up some cells which will then be transferred into a container of liquid.
This will all only take a few minutes. It may be a little uncomfortable but will be less so if you can remain relaxed and take some slow deep breaths.

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