Going for a cervical screening – or smear test – can be a bit daunting, but thankfully most people’s results will come back normal. So, what happens if you receive a letter telling you your smear test found HPV, or abnormal cells were detected?
To mark January’s Cervical Cancer Awareness Month, we asked experts to explain…
Smear tests are designed to prevent cancer
It’s important to be aware that smear tests – which are recommended every three years for women aged 25 to 49 and every five years for women aged 50 to 64 and involve taking a small sample of cells from the cervix – are not designed to diagnose cervical cancer. Instead, they’re designed to help prevent cancer from developing in the first place.
The tests screen for HPV (human papillomavirus) as this is known to be one of the most common causes of cervical cancer. However, even if HPV is detected during your smear, the chances of getting cancer are still low.
“HPV is a very common infection and 75-80% of women and men get it at some stage in life,” explains Narendra Pisal, consultant gynaecologist at London Gynaecology (london-gynaecology.com). What’s more, there are over 100 different types of HPV and only a few are high risk, meaning they are associated with cervical cancer.
While some types of HPV can cause conditions which do have symptoms, such as genital warts, many cause no symptoms at all – meaning people often don’t know they have the virus. “This can sound worrying, but remember that HPV usually goes away by itself, without causing any problems,” says Eluned Hughes, head of health information at Jo’s Cervical Cancer Trust (jostrust.org.uk).
As Pisal explains, HPV infection “can be sexually transmitted but can also be acquired by genital skin to skin contact”, adding that “barrier contraception (such as condoms) is protective to some extent but not 100% effective”.
Because it’s spread via sexual contact, some people feel there is a stigma attached to HPV – although anybody can potentially be infected.
“It’s not uncommon for patients to describe feelings of guilt or shame when they learn they have an HPV infection,” says Julie Bowring, consultant gynaecologist in sexual and reproductive health at London Gynaecology. “More awareness is needed in order to overcome this, as the vast majority of adults will have been exposed to HPV at some point in their life.”
What does it mean if your smear test is HPV positive?
Most people will have a HPV negative result. But if yours comes back positive, it will be one of two things: HPV positive but no abnormal cells, or HPV positive and abnormal cells detected.
If there are no abnormal cells, you will likely be invited for another smear test in one year (rather than the routine three or five years) to check the HPV is gone.
“There is no treatment for HPV itself,” says Hughes. “But there are treatments for conditions caused by HPV, including genital warts, cervical cell changes and cancer. Usually, our immune system gets rid of HPV without treatment. But sometimes the immune system can’t, and this is called a persistent infection.
“A persistent HPV infection causes the cells of the cervix to change. Over time, these cells may develop into cervical cancer if not monitored or treated.”
Providing these steps happen early enough, cancer is still a very rare consequence.
“From acquiring HPV infection to getting cervical cancer it takes between 10 to 15 years, which gives plenty of time for prevention through smear tests,” Pisal says. “If women undergo routine and regular smears, HPV infection and precancerous lesions can be easily detected and treated, thus effectively preventing cancer.”
What if my smear finds abnormal cells too?
Pisal says: “An abnormal smear does not mean you have cancer. Almost always, the abnormality is precancerous and will either resolve with time or can be easily treated.”
You’ll be asked to have a colposcopy as a next step. “This is where the cervix is examined in greater detail under magnification and a biopsy may be taken if necessary,” Pisal explains.
“As an experience, it is very similar to having a smear test performed.” And as mentioned, when necessary, treatments are available which can treat and remove precancerous cells.
What about the HPV vaccine?
There is now also a HPV vaccine offered as part of the NHS vaccination programme to girls and boys aged 12 to 13 years born after September 1, 2006.
As Bowring says though: “The HPV vaccine provides a high degree of protection against cervical cancer – however it does not provide full protection. Therefore, it is very important that you still attend regular screening even if you have been vaccinated, to reduce your risk and have maximum protection.”