Five-minute test that can save the lives of women everywhere
As UK Cervical Cancer Prevention Week kicks off on Monday, experts answer the questions about this deadly disease
While cervical cancer is the 12th most-common female cancer in UK, it's the number one cancer in women aged under 35.
The good news is, a significant number of cervical cancer cases can actually be prevented - by going for your smear tests, which are offered on the health service every three years to women aged 25-49 and every five years for those aged 50-65.
Smears don't diagnose cancer, per se, but they can detect abnormal cell changes at an early stage which may later - particularly if left untreated - develop into cancer.
In spite of this, many women - one in three of those aged 25-29 - fail to attend screenings when invited.
It's now well-documented that human papillomavirus (HPV) plays a major role in cervical cancer. Smoking can also increase a person's risk.
But are you smear savvy? Unsure what's normal and what's not? Here, consultant gynaecologists Deborah Bruce and Nitu Bajekal clear up some common queries.
Q. I caught HPV when I was 20. Nine years on, it's always at the back of my mind. Am I destined to get cancer?
A. Deborah Bruce: No - the risk of developing cervical cancer, even if high-risk HPV positive, is very small. There are around 140 types of HPV, some called 'high-risk' subtypes - types 16 and 18 are thought to be responsible for causing 70% of cervical cancers. Others are low-risk, which do not cause cancer but are responsible for skin warts, including genital and anal warts.
However, there are things you can do to reduce your risk. Ensure you attend your smears. If any abnormalities are found, your sample will be tested for high-risk HPV.
Stopping smoking has also been shown to reduce your risk of developing cancer. You may also wish to consider obtaining the HPV vaccination course; while not available on the NHS for your age-group, it can be obtained privately.
Although not 100% effective, using a barrier method of contraception, such as condoms, can reduce the risk of transmission and re-infection.
Q. After my last smear, my results were "abnormal" and I was called back for another test. After that, they said nothing needed to be done. I can't help but worry. Am I "high risk" for cancer?
A. This could have been a number of things, such as an inadequate sample. Usually, if a mild, or borderline, abnormality is found, you would have been referred for further investigation with a colposcopic assessment.
As the repeat test was completely normal, you can be reassured that either no HPV was detected, or that your immune system has cleared the infection itself.
You do, however, still need to attend your regular cervical screening tests every three years, and reduce your risk of developing cervical precancerous changes and contracting HPV in the future by always using condoms, not smoking, and considering obtaining the HPV vaccination.
Q. My mum had cervical cancer. Now I'm so anxious that I might have it, but I'm 19 and too young for a smear.
A. It's quite understandable to be concerned, but there's no known genetic link for cervical cancer (unlike breast and ovarian cancer).
However, I would advise that you consider obtaining advice regarding the HPV vaccine, which could reduce your risk of contracting the high-risk cancer-causing HPV. The NHS cervical screening programme changed its policy in 2012 to start screening at age 25; I would strongly advise you attend when your time comes.
Q. The HPV vaccine wasn't around when I was younger, but I've heard some people have it without knowing. Should I be concerned?
A. As much as half the population will be infected at some time in their life. In most cases, the virus does no harm because your immune system gets rid of the infection, but in some cases, infection persists and can lead to health problems later.
Using condoms can help prevent HPV. However, as condoms don't cover the entire genital area and are often put on after sexual contact's begun, they're no guarantee against HPV.
Smear tests now routinely test for "high-risk" strains of HPV, if your cervical smear shows mild or borderline changes. You can obtain an HPV assessment privately on all smears, but this will incur a fee.
If the result's negative, you may have had it in the past but your immune system has cleared the infection. If you are positive, you should be aware that you are at increased risk (albeit small) of developing cervical cancer.
You'll be referred for further investigation (and possible treatment) with a colposcopic assessment of the cervix.
Q. I've been on the pill for 12 years, but I've heard that being on it a long time can increase your risk of cancer. Should I stop taking it?
A. It's important to stress that the pill's not associated with an overall increased risk of cancer.
Taking the pill for at least three years reduces the risk of ovarian, endometrial and colon cancer for women, compared with non-users. There's some evidence to suggest women on the pill for more than 10 years have a four times higher risk of cervical cancer, but, that said, the absolute increase in risk is very low and your overall risk is extremely small.
The benefits of taking the pill generally outweigh the risks for most women.
You could discuss with your doctor to help you consider another form of contraception, such as the coil or implant.
What is important, is that you don't stop the pill suddenly and run the risk of unwanted pregnancy.
Regular smears for all women over 25, whether they use the pill or not, will reduce your risk of getting cervical cancer by 80-90%.
Q. I'm 35 and my periods have recently become extremely heavy. Is this normal?
A. Periods are considered heavy if they interfere with daily life. Medically, heavy periods (menorrhagia) can cause anaemia (low-iron levels), making you tired.
Periods can be heavy when they last longer than normal (usually five to six days) and/or if the flow is very heavy, with clots or flooding.
One in five women aged 30-50 is affected and most don't have anything seriously wrong with them. However, a significant number may have polyps or fibroids, which may make periods worse.
It's important to seek medical advice if your periods have been heavy for the last three months, or if you're feeling particularly tired. Your doctor may recommend blood tests and an ultrasound scan and suggest treatment, or referral, as appropriate.
If you're having irregular bleeding, bleeding between your periods or bleeding after intercourse, you should not ignore these signs - see your doctor as soon as possible. Precancerous and cancerous changes are more likely to cause erratic bleeding, rather than just heavy periods.
Q. I've noticed a bit of bloody discharge after sex and between periods. It's never very much, but should I get checked out?
A. Post Coital Bleeding (PCB) is something you should not ignore - seek medical advice from your doctor or sexual health clinic. This will allow for a detailed history and examination.
You may also be offered a smear if you're aged between 25-64, and haven't had one recently. There are several causes of bleeding between periods or after sex, including infection, polyps, atrophic vaginitis, vaginal tears and cervical ectropion. In some situations, bleeding after sex can be a sign of cancer.
If you've had regular clear smears, though, it's highly unlikely this is the cause, but if you're concerned, see your doctor.
Q. I often get pelvis pain and shooting pains in my cervix. I've read that cervical cancer can't actually cause pain until the late stages, but should I be concerned?
A. It's quite normal to have occasional low tummy, or pelvic, pain and even shooting pains in your vagina and cervix. These are not really signs of cervical cancer. It is true that cervical cancer does not usually cause pain until a late stage.
However, the most important way you can reduce your risk of cervical cancer is by attending for your regular smear checks.
You should also seek advice from a doctor if you are having bleeding after sex or erratic bleeding between your periods.
‘I’m just really glad that I had it done’
Jorgie Taylor (40) is from Portavogie and is mum to Gemma (20), Christopher (19), Sammie (14) and Blake (10). She says:
I was diagnosed with cervical cancer in November 2013 after going for my first ever smear test. I had never had one done before because I was too scared and also because I felt there was a bit of a stigma around it.
I know now it’s a silly thing to think, but because of the HPV virus and the connection to sex, I thought it was considered a ‘dirty cancer’, so when I started having a gut feeling that I might have it, I just ignored the signs. I was having discharge and a pain in my groin and just didn’t feel right.
Also, my periods had always been regular, but they started coming every 25 days or 32 days instead. There was also the dignity part to it. I was just petrified about the whole process.
I put my symptoms down to stress for a while, but then I knew I had to go and have a smear done. I’m in the 1% of people diagnosed with cervical cancer who didn’t have HPV.
I was at stage 1b2, which is an early stage of the cancer. Once you hear that word, cancer, you just go into a blind panic. That first Christmas after the diagnosis was awful. I didn’t know how bad I was or what to expect.
I had the LLETZ procedure done, where they remove a proportion of the cervix to see if there’s a clear margin.
They couldn’t get one, so I had to wait eight weeks to heal to have it done again. After that I was told the next step was a radical hysterectomy and the removal of my lymph nodes. I didn’t have to undergo chemotherapy. I told my children and felt a weight off my shoulders when I was able to tell family and friends. I had the hysterectomy done in April last year.
I feel fine now and I’m clear of the cancer, but I have to admit, I do worry about it coming back somewhere else.
I know I’m lucky, though, and I’ve learned to appreciate what I’ve got. I’m so glad I went for the smear when I did and I believe it saved my life. I've had great support from other women I’ve met on a local cervical cancer support group on Facebook.
It helps to know I’m not the only one who has gone through this. And I would definitely urge young girls and women to go and have the test done. Five minutes of discomfort could save your life.”
For further information on the charity Cervical Cancer NI, visit www.facebook.com/groups/fightit/cervicalcancersupportpage