Cervical screening can be a topic of discomfort or embarrassment for many women, but the importance of the more commonly known ‘smear test’ is tenfold. There are misconceptions and myths that lead to missed invitations, which the government and health organisations alike have been addressing through public campaigns.
According to Cancer Research UK, there are around 3,200 new cases every year, yet 99.8% of cervical cancer deaths could be prevented.1 In England, 70.2% of eligible individuals aged 25 to 64 were adequately screened in 2020-21, however this is a 2% decrease on the previous year, when coverage was 72.2%.2
There are many reasons why women may not attend a screening, but one big misconception is that the test is for cancer - and this is not the case. It’s a test to help prevent cancer. During the screening a small sample of cells will be taken from your cervix and examined for any abnormalities, such as those caused by a form of human papillomavirus (HPV) that could potentially become cancerous over time. Finding these changes early means they can be monitored or treated, so they don’t get a chance to progress to cervical cancer.3
We know that embarrassment and fear can cause women to put off going for a test, but it’s important you know what it’s for and what the results mean, so you can make your decision about going, armed with all the information you need.
To put things into perspective, on average, out of every 100 women who have a cervical screening, 94 will have a normal result, while 6 women will have abnormal cells detected. Of these, 2 will have no HPV infection (and therefore will receive further screening invitations every 3 or 5 years) and 4 will require a colposcopy (a procedure involving internal examination) by referral to a gynaecologist.
Some typical barriers identified by Public Health England as to why women don’t attend their cervical screening, include:
1. Lack of knowledge about cervical cancer and the purpose of cervical screening
Jane Chalmers, cancer care nurse at AXA Health, says: “It’s really important that women know why they’re being asked to attend a screening. For many women, when they see or hear the word ‘cancer’, which is big and scary and something we don’t want to think about, their first reaction is to bury the unwanted thoughts and put it off.
But the screening isn’t to detect cancer, it’s to identify early warning signs which, if detected in time, can help prevent the risk of cervical cancer developing altogether. Cervical cancer is avoidable and treatable, if pre-cancerous cells are detected early enough. As a woman, it’s one of the best things you can do for yourself to help avoid it.”
2. Embarrassment about the test
“This is a common reason and completely understandable. You might think it’s undignified, or worry about how you look ‘down there’. But the nurse really doesn’t give any thought to the aesthetics of your undercarriage! They know you might be feeling anxious and will do their best to calm your nerves and make the process as quick as possible. I always remind women that the nurse will have been through it too, so she’ll know what’s likely to be going on in your mind.
“The test itself only takes a matter of seconds, or minutes at most. Then you can sit up and have a private moment to pop your underwear back on. I often recommend women wear a long skirt or t-shirt so they can cover themselves straightaway before putting pants back on,” says Jane.
3. Fear of pain
“Again, this is a very normal reaction, however while some women may experience mild discomfort (similar to menstrual cramps) you definitely shouldn’t feel any pain. If you do, tell the nurse. She may be able to make you more comfortable and can stop the procedure at any time if you wish. Throughout your test the nurse will explain what she’s doing so you’re aware of what’s going on,” says Jane.
“At the end of the day the procedure is usually over and done with in about 30 seconds, so any discomfort is short-lived and a small price to pay for the benefits of attending screening.” Read our article for more information on what to expect when you go for a cervical screening test.
4. Fear that the test will result in a cancer diagnosis
“The test is designed to detect pre-cancerous cells, which could be early markers of cervical cancer. This means they can be treated or removed to prevent cancer developing. It’s rare to find cervical cancer through screening. If you’ve never had a smear test and now worry that by going for one, you may be diagnosed with cancer, it’s important to remember that your risk is still relatively low,” says Jane.
According to Jo’s cervical cancer trust, it’s estimated that in the UK, a woman's lifetime risk of developing cervical cancer if she does not attend cervical screening (smear test) is 2%.4 It’s also treatable, with a survival rate of more than 60% of people living 5 years or more after diagnosis. This figure rises to 95% if the cancer is diagnosed at its earliest stage.5
“The most important thing to bear in mind is that in the unlikely event that your worry is founded, the sooner any signs of cancer are detected the better. So I would urge anyone in this situation to ‘woman up’ and get tested! The most probable outcome is that you can stop worrying, and by attending regular screening going forward, you'll dramatically reduce your risk of ever developing cervical cancer."
5. Access to screening and appointment times are inconvenient
“This is something I hear quite a lot, especially in more remote areas. However, it’s important to remember that if you can’t or don’t want to see a nurse in your local GP surgery, there are other places you can go for surgical screening. These include some NHS walk-in centres and sexual health clinics. Search for these services by location on the NHS website. The test can also be done privately through one of the larger healthcare providers or a local independent gynae or well woman clinic, provided you meet eligibility criteria.
If you choose to go down the private route you’ll usually be seen more quickly – in some cases, on the same day – and have more flexibility in terms of appointment times, but you’ll have to pay for the added convenience.
6. They don’t think they’re at risk
“There are a number of misconceptions around whether or not cervical screening is necessary. Perhaps the biggest myth is that it’s just for women who are sexually active, so if you’re a virgin, or you’ve stopped having sex, or you’ve only had sexual contact with another woman you don’t need to be tested. To be absolutely clear, this is NOT the case!
Nor does having had the HPV vaccine – or more bizarrely, never having had a cold sore – mean you shouldn’t be tested,” says Jane.
“The general rule is that everyone – women or transgender men – with a cervix, aged 25 to 64, are at risk of cervical cancer and should go for cervical screening when they’re invited. There are usually only two valid reasons for not attending. The first is if you’re pregnant – because it can make it difficult to interpret the results. If this is the case, tell your doctor or nurse why you can’t attend and arrange to have the test (or put a reminder on your calendar to make an appointment for one) 3 months after you give birth. The second is if you’ve had a surgical procedure to remove your cervix, e.g. total hysterectomy or Manchester repair, so the test is unnecessary.”
So now we’ve set the record straight about the who, what, why and where of cervical screening, here are Jane’s tips on how to minimise any discomfort and make getting tested as quick and seamless as possible.
Top tips for cervical cancer screening
- The best time to have the test is mid-cycle. It’s possible to have the test while menstruating but it can be harder to analyse the results – and the test may have to be repeated.
- Remember you can ask for a female doctor or nurse to carry out the test.
- You may also choose to ask for a chaperone during the test, or take a friend with you.
- If you’ve experienced discomfort during a previous cervical screening test or have any particular concerns, let the nurse know so she can do what she can to make the procedure more comfortable. This may mean taking more time to talk you through the procedure and making sure you’re happy to go ahead, or using a smaller speculum, for example.
- Relax, relax, relax. OK, so that may seem like a big ask but it is possible. Try focusing on a particular spot in the room and take long, deep breaths. The more relaxed you are, the less likely you’ll be to feel any discomfort and the sooner it’ll be over.
- Think about what to wear ahead of your appointment. This probably isn’t an occasion for a jumpsuit or all-in-one, which will mean you getting pretty much naked from the off! As mentioned previously, a dress or long top that you can pull down immediately after the test can help you feel less exposed.
Finally, it’s worth bearing in mind that many women experience a sense of empowerment after getting screened and feel compelled to protect and empower other women.
“I like to think the sisterhood is strong, so if more women support and encourage other women, it can be a powerful motivator,” says Jane. “If you manage to get one reluctant friend to go for a smear test, you’ll have done an amazing thing for them. You could offer to go and wait with them, and toast them afterwards with tea and cake.”
A note about self-sampling
Our hope is that this information will help encourage more women to make – and keep – their appointment for cervical screening when they receive an invitation. And if they can encourage anyone else they care about to do the same, all the better.
For anyone who still can’t be persuaded to attend screening, there is an alternative, which may become more widespread as the government and public health agencies look for ways to improve take-up.
Self-sampling is one way women can be tested without the need to attend a clinical appointment and avoiding the embarrassment that that can entail for some. It could also be of enormous benefit to survivors of sexual violence, women with a physical disability, those whose beliefs are a barrier to attending traditional screening and those who simply have difficulty booking an appointment that fits with their busy lives.
Increased evidence shows that self-collected samples can be as accurate as clinician-collected samples, and other countries that currently offer self-testing and have seen very encouraging results. NHS England have just completed their pilot scheme (December 2021) where they sent home-testing kits to 19,000 women, and offered a further 12,000 via GP surgeries, in North and East London. Results for this trial are still to come.
If successful, the kits could be offered to all women, leading to more of us being screened and cervical cancer being prevented entirely, or diagnosed at an earlier stage.
Self-sampling won’t put an end to the smear test completely; if their sample is found to be abnormal, women would still be invited to have a standard cervical screening test taken by a doctor or nurse.
Further reading and resources
Private smear test – AXA Health
Cervical screening – NHS factsheet
The Eve Appeal (for gynaecological cancers)
4 Risks and causes of cervical cancer - Jo’s Cervical cancer trust
5 Cancer Research UK. Cervical cancer survival statistics. Accessed: 04.03.2022.