Frequently asked questions on Cervical screening
Why should I take up my cervical screening invitation?
How many women attend cervical screening in the UK?
Around five million women are invited to attend cervical screening each year. Since 1997, the number of women attending screening in the UK has ranged from 77 to 83%. There has been a recent and worrying trend of fewer women attending screening; especially in the 25–29 age group, with one in three not taking up their invitation in 2014/2015. Also, across the UK figures for those not attending screening show a significant rise as age increases, suggesting that as women age, they consider screening less important.
Who is eligible for a cervical screening on the NHS?
Across the whole of the UK women are invited for cervical screening between the ages of 25 and 64. Women aged 25–49 are invited every three years and women aged 50–64 are invited every five years.
In 2012, the UK National Screening Committee, an independent, ministerial appointed committee, advised the NHS Cervical Screening Programme recommended that there is a consistent screening age across the whole of the UK. Scotland changed its screening age on the 6th June 2016 in line with England, Northern Ireland and Wales.
Is cervical screening painful?
Around five million women in the UK have a cervical screening every year; 90–94% of whom receive a normal result. The procedure should not be painful, but some women can experience a degree of discomfort and even short-term mild pain. Being screened (especially if it's the first one) can be daunting for some, so it may help to find out beforehand exactly what happens during a cervical screening appointment.
The appointment should take no longer than around 20 minutes, with the procedure itself taking approximately three minutes. If you feel any pain and/or discomfort during the procedure please inform the practice nurse. Speculums come in different sizes so you can ask for a smaller one to be used if you are uncomfortable/in pain.
What is the difference between cervical screening and a smear test?
There is no difference between cervical screening and a smear test; they are two different names for the same procedure. Smear test is the older name for the test and it relates to the way the test used to be taken: cells were smeared on to a glass slide and the slide was sent to the laboratory. The test is different now and so most health care professionals use the term cervical screening. Your invitation letter will invite you to attend cervical screening, which is why it is the term that we use here on the website and in all of our information materials.
Where can I go for my cervical screening?
Can I go for my cervical screening when I am pregnant?
Every woman's screening history is different and offering a cervical screening when she is (or might be) pregnant will be dependent on this history. If you have had abnormal result in the past, have never had a cervical screening or have not attended previous invitations for screening then you should consult your doctor or practice nurse to ask for advice.
Should lesbian and bisexual women go for cervical screening?
Yes. All women, regardless of their sexual orientation, who are over the age of invitation should have regular cervical screening. Most cervical abnormalities are caused by persistent infection with HPV. As HPV can be transmitted through skin-to-skin contact in the genital area, gay women are equally at risk of contracting HPV and experiencing abnormal cervical changes and, thus, should always attend when invited for cervical screening.
Is there anyone who may not need to go for cervical screening?
A small minority of women may not need a cervical screening.
Women who have never been sexually active:
- The incidence of cervical cancer is extremely rare in women who have never been sexually active and the guidelines issued suggest that women who are sexually active attend for screening at the age of 25. More than 99% of cervical cancers are linked to infection with sexually transmitted high risk HPV so it is recommended that if you have ever had sexual intercourse or genital-to-genital contact with a man or a woman, even just once, then you should attend for regular cervical screenings.
- If you are not currently in a sexual relationship but have been in the past, you are recommended to have regular cervical screening.
Women over 65:
- Women aged 65 and over who have had three normal test results in a row are not called back for further cervical screening tests. It is very unlikely that women in this category will go on to develop cervical cancer.
- If you are over 64 and have had abnormal results, you will continue to be invited for screening until the cells return to normal. Women aged 65 and over who have never had screening are entitled to a test.
- If you have never had a screening test and have been sexually active, you should have a test, regardless of your age.
Certain groups of women who have had hysterectomies:
- Some women who have had a hysterectomy are still thought to be at risk of developing abnormal cells and so should continue to have regular cervical screenings. For example, if your womb was removed but you still have your cervix, you should continue to go for regular screening.
- If your womb and cervix were removed to prevent or treat cancer, you may still be asked to have a vaginal smear (vault smear) for a short period of follow-up. If your womb and cervix were removed for a benign (non-cancerous) condition, such as fibroids or heavy bleeding, you do not need to have any more cervical screenings. In general, if you do not have a cervix then you do not need to attend a cervical screening.
How long will I have to wait for my cervical screening results?
As cervical screening tests are reviewed by specialists who examine the cells under a microscope, the length of time taken to receive your screening results can vary. NHS guidelines state that you should receive the results of your screening within two to six weeks depending on where you live in the UK, so be sure you ask when they will let you know your test result when you have your screening.
If there are no abnormalities seen you will be sent a letter confirming the result by your local screening office. Sometimes the hospital may contact you with the result. Some GP's surgeries request the patient to ring for their result – remember to check if they would like you to do this.
Are the results of cervical screening reliable?
Cervical screening is 80–90% reliable and can prevent 60–80% of cervical cancers. This means that seven out of every 10 cases of women who would have developed cancer of the cervix can be prevented .
- Sasieni et al., 2009. Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data. British Medical Journal 339, 1–7.
Why are some cervical abnormalities missed?
There are several factors in the taking and reading of cervical screenings that make it impossible to be 100% accurate. A cervical screening is a sample of cells taken from the surface of the cervix. Since it is only a sample, the cervical screening does not always accurately reflect what is occurring in the whole of the skin layer – and it is the latter that is important for making an accurate as possible diagnosis and, of course, attend screening when invited.
Will a cervical screening give a final diagnosis?
No. It is important to remember that cervical screening is a screening test and not designed to give a final diagnosis. It is used to detect early cervical cell abnormalities which, if left untreated, could lead to the development of cervical cancer at a time in the future. It is understandable if you feel anxious after receiving an abnormal result, but it is more important that you know and understand what the abnormality is so you can discuss the results with your doctor and arrange appropriate follow-up.
Does an abnormal cervical screening mean I have cancer?
No. The vast majority of cervical screening results are normal, but a very small percentage of the total screenings reported on every year are described as being either 'inadequate' or having a grade of abnormality. The majority of these abnormalities reflect precancerous changes in the cells of the cervix, not cancer.
Why do some women get abnormal results and others never do?
Almost all women will be infected with HPV at some point in their lives, but less than one in 10 will have an abnormal screening result. We do not know why this is. In some women it may be related to the immune system's ability to get rid of this virus quickly.
If cervical cell abnormalities have been detected this does NOT mean that you have cervical cancer or that you will get cervical cancer in the future. What it does mean is that some of the cells of your cervix are slightly abnormal and that, if left untreated, they could go on to develop into cervical cancer at a later date.
Medical research has yet to establish why some women have persistent HPV infection, develop abnormal cell changes or develop cervical cancer. This is why it is important for all women to attend their NHS invitation for a cervical screening.
Is having cervical screening like having a gynaecological MOT?
No. Cervical screening is designed solely to detect early cervical cell abnormalities which, if left untreated, could lead to the development of cervical cancer at a time in the future. It is not designed to detect abnormalities in the ovaries, the womb, the vulva or the vagina. However, having a regular cervical screening does give the opportunity for the cervix to be examined.
I have always had clear screening results, should I opt out of the screening programme after 50?
Making a decision about whether to attend cervical screening is always your choice. Having regular cervical screening offers the best protection against developing cervical cancer. Cervical cancer is caused by the HPV virus. Anybody who has ever been sexually active is at risk of contracting HPV. HPV is transmitted through skin to skin contact of the genital area, so if you are having sex (or have had sex in the past) you could be at risk of HPV and cervical cancer. Since screening offers the best protection against developing cervical cancer it is advisable to continue attending your screening appointments when you are invited. You will be invited to attend cervical screening until 64.
Why does cervical screening stop at 64?
Women aged 65 or over are taken out of the national screening programme unless they need ongoing follow-up. This is generally required if a woman has had an abnormal result in any one of her three most recent cervical screening tests or if she is recommended for early repeat screening due to a previous cervical abnormality.
When we consider the way cervical cancer develops and with the knowledge that a woman has had three negative screening results in a row, it is highly unlikely that women 65 and over will go on to develop the disease. For women eligible for screening, attending screening offers the best protection against developing cervical cancer.
Women aged 65 and over who have never had a test are entitled to one.
Is cervical screening more painful after the menopause?
Every woman is different and her experience of screening will be unique to her. Your sample taker (usually a female practice nurse) will be trained to take your cervical screening test irrespective of whether you have been through the menopause or not. However, after menopause the vagina walls and entrance to the vagina can become smaller, women may also make less natural lubrication and this can make the insertion of the speculum (an instrument used to open the vagina so the sample taker can see the cervix) more uncomfortable.
After the menopause oestrogen levels in the body fall, which causes a condition called atrophic cervix. This happens to every woman. The cells of the cervix do not shed as easily as a woman who has not been through the menopause. This can sometimes produce an 'inadequate' cervical screening test result as not enough cells can be collected. If this result occurs you may need to come back to repeat the cervical screening test. Your screening results letter will let you know what you need to do.
Here are some tips to make cervical screening easier after the menopause:
- There are different sizes of speculum and you can ask for a smaller size to be used if you wish to
- If you've had problems with screening in the past you can ask your practice nurse to prescribe local oestrogen, which can help to make inserting the speculum easier and less painful
- Tell the sample taker if you are feeling uncomfortable or have had a previous screening experience that was difficult.