Cervical cancer: Why we need to talk about abnormal smear results

IT might seem like health headlines are nothing but doom and gloom these days – but there are still shining success stories to celebrate. Cervical cancer prevention is one area where progress is saving thousands of lives.

Across the water, in the NHS, its cervical screening programme (aka smear tests) has seen significant developments since starting in the 1960s and now prevents around 75% of cervical cancers each year, as leading cervical cancer charity Jo’s Cervical Cancer Trust points out. 

The HPV (the main cause of cervical cancer) vaccination programme, now offered to boys and girls in schools, is doubling down on the battle.

“We could get to a point where this becomes a cancer that almost doesn’t exist, or just exists in very small numbers,” says Jo’s chief executive, Samantha Dixon.

“There are countries such as Australia who are ahead of us and really making paths to eradicate cervical cancer. It’s amazing, which is why it’s so important people understand the role of cervical screening and vaccination.”

In Ireland a human papillomavirus (HPV) school based vaccination programme began in Ireland in 2010. The vaccine is offered to all girls in first year of second level school (age 12- 13 years) to protect them from cervical cancer in adulthood.

Prevention is better than cure

HPV is an extremely common virus transmitted through sexual contact, which 80% of people will come into contact with at some point.

Many strains are harmless and don’t cause problems – but some strains are considered high-risk and 99.7% of all cervical cancer cases are believed to be caused by these, so tackling HPV is an important step in the fight against the disease.

Smear tests, meanwhile, are not designed to detect cancer but to pick up HPV and early signs of cell changes, which could in some cases develop into cancer. 

This means women and people with a cervix can be monitored and, if needed, given treatment as a preventative measure.

What does an abnormal smear result mean?

Saving lives might be the ultimate goal – but there’s a lot more to the picture, including people’s wellbeing as patients.

Jo’s Cervical Cancer Trust is keen to highlight the importance of reducing HPV stigma, and talking more about what it means to get an abnormal result and go for further tests (such as a colposcopy) or treatment (such as LLETZ, where a thin wire loop is used to remove the area of the cervix with abnormal cell changes).

Around 220,000 women are diagnosed with cervical cell changes every year. However, according to a new survey by the charity, over a quarter (26%) say they felt ashamed, with 34% saying they felt anxious, and 21% saying they felt isolated and didn’t want to tell other people. More than half (51%) said they knew nothing about what this meant before receiving their results.

When it comes to treatment, many felt uninformed and unprepared, with 42% saying they didn’t feel they had enough time to consider their options, and 28% experiencing side-effects they either didn’t expect or which were more severe than expected.

“There’s so much attention on cervical screening, which is fantastic, but not many people talk about what it means to have an abnormal result. 

"Every day, we get so many people coming to us at Jo’s saying, ‘I don’t know what this means, I’m really scared and, worse, feeling ashamed or embarrassed’. We want to get more conversation going, talking about what it means to get an abnormal result, so people know what to expect,” says Dixon.

“For example, we get so many women saying they went for treatment and didn’t realise they would need to take it easy afterwards, so they went straight back to work and then really struggled. Nobody had really said, ‘This is what’s going to happen and you might feel this way afterwards, so just take it easy and look after yourself’,” says Dixon.

“And the shame as well. Such a high number say they’ve felt shame after their results and treatment, and that just shouldn’t be something people need to feel. Talking about it is how we can help normalise it.”

Are you overdue a smear test?

There has been a drop in people staying up to date with their smears due to the pandemic, and uptake is at the lowest it’s been in decades. Catching up with routine healthcare is vital though.

For more on cervical screening in Ireland see https://www2.hse.ie/cervical-screening/