Tuesday 17 September 2019

What should I do for my next smear test? Well Woman doctor explains the best options

Sasha Brady

Dr Shirley McQuade, medical director of Dublin Well Woman Centre, spoke to Independent.ie and set out facts and advice for women concerned about smear tests.

What is a smear test?

A smear test is the best test we have to check for cervical cancer. What we're really looking for is per-cancerous changes and getting things before they progress as cancer.

What happens after screening?

We take the test from the patient's cervix. It's sent to a laboratory and they do cytology on it, which is looking at the cells to see if there are any cell changes.

They look to see why the cells are changing. Cells are always changing because of the Human Papilloma Virus (HPV) but there are types of HPV. Some of are high-risk HPV, some of them are low-risk HPV.

What do different results mean?

A lab can now tell us if someone has changes in their cells and whether they're going to progress.

If they have high-grade changes, high-grade HPV, they possibly will progress but not always.

If they have low-grade HPV, even though there are some changes going on, we know that they're not going to progress. So those women with minor changes, with low-grade HPV, do not need to have additional tests.

The women who have high-grade HPV with minor changes are referred to colcoscopy departments.

How effective is smear test screening? What are false positives and false negatives results?

The difficulty with pap smears is that they're not going to be 100pc accurate but then no medical tests are.

False positive results look like there may be changes going on but when the patient goes to a colcoscopy clinic and they have a better look with the microscope, they discover that there are no changes or they are insignificant changes.

Sometimes there are false negatives where the smear tests does not detect cell changes happening.

The thing about cervical cancer is that there is usually a long progression from minor changes to medium changes to high-grade changes before it gets to cancer.

So if someone is having regular screening, even if the something is missed on the first check, it will usually be picked up on the second check.

Screening is about turning up for smear tests and having repeat tests for several years.

What is the difference between public and private screening?

What CerivalCheck have said in relation to additional testing is that they will fund additional tests for anyone who is concerned about their smear tests. Women do not have to pay.

Privately, they can if they wish. It can cost between €85 and €100.

In this clinic, both our private and public smear tests go to The Coombe.

If someone wants to have a private smear test, the advantage there is that the test will be done more quickly.

Typically the turnaround time on private smear tests is two weeks. But again, with more people requesting smear tests, it will probably be a little longer.

If someone goes into the public system and they had a smear test last year, if they're really worried - and most people shouldn't be - they can come and have a smear test done. It will be put into the public system and it will take between five to seven weeks.

What’s the difference between a smear test and the HPV test?

Currently we use combination of cytology, looking at the cells, followed by HPV typing.

In autumn, the plan is to change to HPV typing first. Only if there is high-risk HPV present in the sample will they go on and do cytology on the sample.

With HPV typing you don't need as many staff, it can be more automated. If a machine detects HPV then staff will come in and do cytology. It should be a more efficient and effective way of analysing samples.

What is the message for women now?

If you are someone who has symptoms, you should go get checked anyway.

If you have a smear test history reaching back several years of all normal, negative smear tests then you shouldn't be concerned.

But if you are really concerned, you can get a smear test either in the public system in CervicalCheck or you can have it done privately, whichever you want.

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