Should you attend a cervical screening? What you need to know

Smear tests are one of the first lines of defence against cervical cancer.

Every year, about 5,000 lives are saved thanks to the screening programme.

But nearly one in three people with a cervix don't take up the offer of cervical screening.

If you're nervous, if it's been a while since your last smear or if you've never had one before - here's everything you need to know.

What is a smear test?

A smear test is another term for cervical screening. You might have also heard it being called a Pap test (short for Papanicolaou and named after the Greek doctor who invented the test).

The test checks your cervix - the opening to the womb - for certain types of a virus called HPV (human papillomavirus) and any changes to the cells there.

These strains of "high-risk" HPV can change the cells of your cervix and cause cancer.

A smear test is not a test to detect cervical cancer - but it can help prevent it. If high-risk HPV is detected, you will be monitored more closely so abnormal cells can be spotted and treated before they turn into cancer.

When do you get your first smear test?

Women and people with a cervix start getting smear tests at the age of 25.

You might get a letter inviting you for a screening up to 6 months before you turn 25.

Below 25, cervical cancer is very rare so you do not need to be tested. Changes in cervix cells are common in this age group, but often return to normal on their own - so screening can cause unnecessary worry.

Between the ages of 25 and 49 you should have a smear every three years, then between 50 and 64 it's every five years.

From 65 you do not need to be screened unless a recent test was abnormal.

How will you know when to get a smear test?

You will get a letter inviting you for a cervical screening.

This will alert you it's time to get a test - but it's up to you to book it. The letter will give you details on how, normally by phoning your GP surgery or using their online booking service.

Some walk-in centres and sexual health clinics also offer cervical screening.

It is best to avoid booking an appointment for when you are on your period, or during the two days before and two days after you bleed.

You should book as soon as possible after getting your letter, but if you've missed an appointment or put off scheduling it, it's never too late to book.

What happens during a smear test?

Smear tests are usually done by a female doctor or nurse. You can request this with your GP to make sure, or you can ask for a man if you would feel more comfortable with this (for example, if you're a trans man).

The screening normally takes less than 5 minutes, and the whole appointment is over in about 10. Some find the procedure painful, but for most it just feels slightly uncomfortable.

Here's what happens:

• You will need to undress from the waist down. This will happen in a private room behind a screen. If you're wearing a skirt or dress you can pull that up and just remove your underwear.

• You will be given a paper sheet to cover your lower half. You will be asked to lie on a bed, usually on your back with your feet together and knees apart. If it's more comfortable, you can lie on your left side with your knees bent.

• The nurse will gently put a smooth, tube-shaped tool (a speculum) into your vagina. They will widen the speculum slightly which allows them to see your cervix.

• The nurse will then use a soft brush to take a sample of cells from your cervix. This only takes a few seconds.

• They will then remove the speculum and leave you to get dressed. The cells will be put in a tube of liquid and sent for testing.

Why is it important to get a smear test?

Cervical screening is one of the best ways to protect you from cervical cancer.

The test picks up changes in the cells of your cervix that may not be causing you any symptoms, but could develop into cancer if left untreated.

It also detects the HPV virus that can cause these changes to the cells.

Julie Roye, head of primary care nursing at East London NHS Foundation Trust, said many people don't come in for their smear because don't know what it's for, don't see the need for it - or say they "feel fine".

"It's not about how you feel - it's a screening tool," she said.

Young people often think they do not need to get screened or forget to book their appointments, she said.

"It's worth noting that HPV can be detected in younger individuals as well," she added.

Bridget Little, Head of Support Services at Jo's Cervical Cancer Trust said: "We understand that it's not an easy appointment for everyone.

"It can sometimes be difficult to attend for a variety of reasons including work and childcare commitments, anxiety, and misinformation surrounding the test. But these tests are vital, they can prevent cancer."

What is HPV?

HPV is the name for a very common group of viruses. There are more than 100 strains and most do not cause any symptoms.

High-risk strains of HPV can change the cells in your cervix, which can develop into cancer over time.

If you have HPV or abnormal cervical cells, it does not mean you have cancer. It means you will be monitored and given treatment if necessary.

Nearly all cervical cancers are caused by HPV, with roughly 14 strains of the virus considered high-risk.

Two in particular, HPV 16 and 18, result in around 70% of all cervical cancer cases, according to Cancer Research UK.

In rare cases, cervical cancer can also be triggered by smoking, having HIV, a family history of the disease, or untreated chlamydia.

What happens after the smear test?

The lab will test your cell sample for HPV first. If HPV is detected, then they will do a second test to see if the cells are abnormal.

You will be sent a letter with your results, which should arrive about two weeks after your test. Here is what it might say:

• No HPV detected. This means your risk of getting cervical cancer is very low and you will be invited for another regular screening in three or five years.

• HPV found, but no abnormal cells. This means the virus was detected, but it has not affected your cells. You will be invited for another screening in one year.

• HPV found and abnormal cells detected. You'll be asked to have a colposcopy, which is a closer look at your cervix with a microscope, done in a hospital.

• Inadequate result. If the results are unclear, you'll be invited back in three months so they can get another sample to test.

Read more:
Cervical cancer symptoms to look for
Little-known STI may increase the risk of cervical cancer

I've had the HPV vaccine - do I still need a smear test?

Yes. The current vaccine protects against the nine strains of HPV that most commonly cause cervical cancer, the one given to schoolchildren before 2012 protected against two.

But there are other types of HPV that can also cause cervical cancer, Ms Roye said.

It's worth considering that people from other countries may carry strains of HPV linked to cervical cancer that are not covered by the vaccine used in the UK, she said.

Some research has been done into whether women will need fewer cervical screens in their lifetime due to uptake of the vaccine. But for now the advice is still to get screened at regular intervals, whenever you get invited to book.

Can I have sex before my smear test?

Yes. Some advice on the internet says you should avoid having sex or using condoms, lube or spermicides in the 24 hours before your smear - but Ms Roye said this is not necessary with the new testing method.

In the past, having sex or using elated products could affect the accuracy of the test, but the current test primarily focuses on detecting HPV.

"No spermicide or sex or condom is going to kill the HPV, because it's a virus," she said.

I'm a lesbian or bisexual woman - do I need to get screened?

Yes. You do not need to have had penetrative sex to get HPV.

You can get it from any skin-to-skin contact of the genital area or sharing sex toys as well as through sex.

I'm a trans man or non-binary person - do I need a smear test?

People assigned female at birth still have the same risk factor for developing cervical cancer, unless you have had a total hysterectomy that removes the cervix.

That makes it important to get a smear test, even if you do not identify as female.

Ms Roye has led changes to make smears more accessible for the LGBTQ community in her area.

For trans men or non-binary people, having a smear may feel like a "violation", she said, and it's important for clinicians to recognise that.

You may want to set up a phone consultation before your appointment to get a clear understanding of why the test is necessary and what will happen during it.

If you're a trans man registered with a GP as male, you will not receive automatic invitations for screening but can ask your GP for an appointment or to be added to the screening programme so you get invitations.

There are some trans-specific clinics that offer cervical screening in London, Liverpool, Brighton and Glasgow.

Trans women do not need cervical screening.

I've never had sex - do I need a smear?

Even if you're not sexually active, you should still book a smear when you get an invitation.

While your risk of developing cervical cancer may be much lower, there is still a risk.

I'm nervous about going to the appointment - what can I do?

You can take a support person with you, who can either stay in the waiting room or come into the nurse's room.

You can also ask your GP surgery if there can be a second member of staff in the room for support - this is sometimes called a chaperone.

Think about any questions you have in advance, and write them down if you think you might struggle to ask them.

Ask your GP surgery if they offer longer or double appointments so you have time to process information or ask questions.

You can ask to insert the speculum yourself if that would make you feel more comfortable.

Bring something to distract yourself - your phone, a book, headphones.

If you feel you are not able to carry on with the screening at any point, you can ask the nurse to stop.

What's the situation for disabled women getting cervical screenings?

Two thirds of women who took part in research by Jo’s Cervical Cancer Trust said they had been unable to attend cervical screening because of their disability.

Every eligible woman between 25 and 64 has the right to cervical screening.

Adjustments GP surgeries may be able to put in place include home visits, arranging for the screening to take place at a different venue, and making a hoist available.

The research by Jo's Trust showed these adjustments are often not offered, and researchers called on GP surgeries to review their policies and practices.