Let’s Talk About It: Cervical Screening, or “The Dreaded Smear”

Picture This/POV:

You’re 24. You stumble back through the doorway after a day at work and you notice a letter on the ground with the swirls of text forming your name. After jostling with your bag in an obviously extremely graceful manner, you reach down and pick it up and take it with you, up the stairs and to your room in the house you share with a ridiculous number of people.

Once you’ve put your things down, you open up this letter and discover it is from the NHS. Here it is: the invitation to your first cervical screening.

*slides letter slowly away*

This month, we have had wonderful events hosted by the Women@Reading Network on menopause and I found them so invaluable and I am so grateful that people have shared their experiences of the menopause so it won’t be such a shock as and when that time comes around for me. When I told my mother we had these events at work, she turned to me and said, “you are so lucky.”

I figured that cervical screening is also something that is not really talked about and so the veil of mystery it wears can make it seem scarier than it otherwise might be. So, this is what this blog post is about. It is for those of you who are seasoned pros by now with this whole screening business, and for those who, like me, are at the beginning of this journey. I like mystery as much as the next person, but not when it comes to gynaecological health.

The letter that came was accompanied by a booklet explaining what cervical screening is. You may know it by its former name, the “smear” test. According to the pamphlet, cervical screening helps prevent cervical cancer and prevents 70% of cervical cancer deaths in England alone. They predict that if everyone attended screening regularly, 83% could be prevented.

I was of the generation that was offered the HPV vaccination when I was at school that we colloquially called, “the cervical cancer jab”. Of course, while no vaccination is 100% guaranteed to prevent an illness, I must admit I felt pretty grateful once I started reading through the booklet for it. I also felt a bit tense. And that’s normal…and why I am writing this. If we talk about it, the reality of it becomes less scary because we can know more of what to expect and stop (or reduce) feeling ashamed or uncomfortable when talking about this real experience that we go through.

The NHS offers screening for people from 25 to 49 every three years and for people aged 50 to 64 every five years. This is because this is when most cervical cancers develop. NHS screening is for anybody who has a cervix. Cervical cancer happens, the booklet says, when cells in the cervix grow in an uncontrolled way and build up to form a lump (a tumour). Nearly all cervical cancers are caused by HPV, which causes the cells in your cervix to become abnormal.

HPV is very common and most people get it during their life. It is spread during any type of sexual activity where there is close skin to skin contact and can stay in the body for many years at low or undetectable levels. So, it may have come from a partner a long time ago. Before you panic, only some “high-risk” types of HPV can lead to cancer and the types that do cause cervical cancer do not cause any symptoms. Usually, the body can get rid of abnormal cells resulting from HPV and the cervix returns to normal. Sometimes, though, this doesn’t happen and the abnormal cells develop into cancer.

If abnormal cells are found during a cervical screening you may be referred to have a colposcopy, usually carried out in a hospital, when a small sample is taken to check any “unusual” (rude!) looking parts of the cervix. If these abnormal cells are serious then you may need treatment to remove them.

There are four outcomes from a screening that the booklet lists:

  1. HPV negative, where no further tests are conducted until your next cervical screening
  2. HPV positive: no abnormal cells, where the sample is positive and you have HPV but no abnormal cells. You will be asked to come for screening sooner than is usual to check if the immune system gets rid of the HPV itself, which happens in most cases
  3. HPV positive: abnormal cells found, where your abnormal cells will be given a ‘grade’ according to seriousness that will be explained to you in a letter. Then you will be invited for a colposcopy
  4. Inadequate result. How unsatisfying, I know. If this happens, you’ll be invited for screening again in three months’ time. The reason for this wait is so there are enough cells from which to collect another sample

Now, that’s a lot of information and, trust me, there is more in the booklet, but I figured I’d leave it there in case you’re either hyperventilating or your head hurts from the amount of info-dumping I’ve just done. What I do wish is that they would prepare you about the experience and the practicalities: will it be uncomfortable or will it be painful? If symptoms of cervical cancer can include things like bleeding between periods, can you go to a screening if you are menstruating or do you need to wait until you’re no longer bleeding? (I’ll ask these questions and get back to you! UPDATE — Here is Part Two which gives the answers to these questions).

It’s kind of scary, but I at least felt a little bit better about the whole matter after reading more and after discussing it with a colleague at work who had gone through it themselves.

So, I called up to book my appointment and, after grooving to the mind-numbing hold music at Chancellor’s Way bus stop for what felt like four hours (it was only 10 minutes), I was told I could book a telephone appointment online…

“Well…” I say, “it’s for a cervical screening.”

“Oh!” says the person on the other end of the line, “that will be the nurse then, so let me check her schedule.”

And I wait again.

And then, “our nurse is away and it doesn’t say when she’ll be taking appointments again, but you can call back next week?”

I agreed to call back next week. And I will. And then I will be back with part two (UPDATE — Part Two, the experience).

I never thought I would be writing about cervical screening as part of my job, but here we are. I decided to write this because of the reasons I stated earlier, but also because not everybody has someone they feel they can talk to about their fears and concerns when it comes to gynaecological health. It has been shunned for millennia, but I believe we are moving beyond that now.

It’s okay to be worried about cervical screening, but the best thing is to get it done. As the pamphlet says, “regardless of your sexual orientation, sexual history, or whether you have had the HPV vaccination,” if you have a cervix it’s best to go to your screening. I’ll always be here to talk and hold your hand in spirit through the whole process.

If you want further support, feel free to join Women@Reading, talk to me, the Diversity and Inclusion Advisor, or someone at work you feel comfortable with. If you have any medical questions, do direct those to your local health practitioner, GP, or nurse.

Thank you for reading!

— Ceara

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