Don’t brush cervical screening under the carpet

IT is estimated that five million women did not attend their cervical screening appointment, in 2024 alone. This has prompted a national awareness campaign of this potentially lifesaving test.

In my own practice, I continue to be surprised how many women are unaware how incredibly effective it can be at preventing cervical cancer, with more than 75 per cent being prevented through this early detection screening programme. Given cervical cancer is one of the most common cancers, you can see why there is a huge drive to encourage uptake.

But why are women not attending? Even for those who understand the benefit, there are reasons for not taking up the screening, including finding it hard to find time in a busy schedule, struggling to get an NHS appointment, or the procedure can feel too exposing and embarrassing.

However, we know that majority avoid screening as the procedure can feel invasive, uncomfortable and provokes a sense of being out of control. For some, it is excruciatingly painful.

If you have had previous traumatic experiences or suffer from painful genital conditions, this can make the prospect of future examination seemingly impossible. These experiences are real and should not be minimised or dismissed.

It’s understandable attending the screening appointment can be a difficult decision and it’s important you feel fully informed to make the decision. If you are feeling overwhelmed, speak to a specialist. We are here to support you.

There may be treatments or support we can provide prior to you having the procedure. Here are my tips to making the procedure as comfortable as possible:

l Ask to book a longer appointment if you are worried about feeling rushed.

l To help you feel relaxed, listening to calming music and practising breathing exercises during the examination can help to reduce anxiety and tensing of vaginal muscles.

l If you have underlying vulval or vaginal conditions, you may benefit from topical treatments such as oestrogen cream and moisturisers, which can be prescribed a few months leading up to the procedure. If it’s possible, using a small speculum during the procedure can make the procedure more comfortable. Water-based lubricants should also be used at the time of the procedure to reduce discomfort. A common incorrect myth is that lubricants impair screening results. This is not the case.

l To feel more in control, you may wish to insert the speculum with the nurse or doctor. Booking a preceding appointment to look at equipment can help you feel more empowered and knowledgeable about the procedure.

As tempting as it is to just ignore the invite, please know it really could save your life!

What you need to know about the cervical screening test:

In England, NHS cervical screening is offered to anyone with a cervix aged 25 to 64, including those in same-sex relationships, transgender and non-binary people with female reproductive organs. Recall is every three to five years, depending on your age.

The screening procedure is usually done in your GP surgery and involves an examination with a speculum to view the cervix (neck of the womb, opening from the vagina) and a soft brush being used to gently sweep cells from the cervix.

Nearly all cases of cervical cancer are caused by certain variants of the Human Papilloma Virus (HPV), which is why the initial screening test is aimed at detecting HPV, not at cancer directly. It is only in some cases that high-risk HPV will lead to abnormal changes on the cervix and, even more rarely, it can develop into cervical cancer. So, if HPV is detected, the cells will be looked at in more detail under a microscope and you will either be offered more regular screening or referred for further investigation to look at the cervix in more detail.

Does having HPV mean you will get cervical cancer?

The majority of people who have HPV do not develop cancer, or even pre-cancer. There are many variants and HPV is a common virus, with most of the population (men and women) getting it at some point in their life without knowing. The virus often clears itself within a few years.

Some HPVs are associated with genital warts and, rarely, some are high risk for cervical cancer as well as other rare cancers such as vaginal, penile, head, and neck. Even if you carry a high-risk HPV type, the chance of getting cervical cancer is still low. The aim of screening is to pick up changes early so that they can be easily treated and do not turn into cervical cancer.

A common question asked is, why are those younger than 25 not routinely invited to screening? This is because developing cervical cancer is rare in this age range. Also, HPV changes that clear themselves are most common in this age range, so screening would lead to unnecessary treatment and worry.

Can you reduce your risk?

There are ways. For example, using barrier contraception (such as condoms) as HPV is usually acquired through skin-to-skin contact. Having a weakened immune system can make it harder to clear the virus. Lifestyle modifications such as not smoking can help prevent this. More recently, a vaccine has become available to both sexes to prevent getting the virus in the first place. It is important to note the vaccine cannot eradicate the virus once you get it. The programme is aimed at younger school children and those under the age of 25, where it is rare to have acquired the virus already.

If you do have HPV, it is not possible to say when exactly the virus was picked up, as the virus can remain in the body, dormant for many years. Most do not know they actually have it.

Will you know if you have cervical cancer?

Cervical cancer is rare. More commonly you may have the HPV or precancerous cells and, for the majority, there are no symptoms, which is why regular screening is important.

HPV screening is not used to investigate symptoms. If you do have symptoms abnormal for you, it is important you speak with your doctor immediately. Such symptoms include bleeding after sex, between your periods, or heavier than usual; changes to discharge; and pain in your lower tummy, or during and sex.

For more information, visit www.eveappeal.org.uk and www.berkshiremenopauseclinic.com
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l Dr Shilpa McQuillan, from Emmer Green, leads Berkshire Menopause Clinic in Henley. For more information, visit www.berkshiremenopauseclinic
.com or email info@berkshire
menopauseclinic.com