Thursday 17 October 2019

What happens when you get a smear test? A step-by-step guide to cervical screening

A plastic speculum, used during a smear test
A plastic speculum, used during a smear test

Meadhbh McGrath

When women in Ireland reach a certain age, they’ll find a very important letter in the post box – an invitation to their first smear test.

The CervicalCheck program offers free screening for women between 25 and 60, and while younger women may feel nervous or uncomfortable, experts urge women to have regular smear tests once they turn 25.

We spoke to Dr Gráinne Flannelly, clinical director of CervicalCheck, about what to expect from your first smear test.

Finding a smear taker

Once you receive an invitation letter, you can search on to find a smear taker in your area – there are over 4,500 nationwide. You don’t have to go to your GP, you can simply make an appointment once you are eligible.

Before the smear test

When you arrive at the clinic, you’ll have a chat with the smear taker, and you can let them know if you’re feeling nervous.

Then you’ll be left alone for a few minutes to remove your clothes – you might prefer to wear a skirt to make it easier to change before and after. When you’re ready, you’ll sit on the chair or bed, covered with a piece of paper.

Free screenings are available free of charge to women between the ages of 25 and 60.
Free screenings are available free of charge to women between the ages of 25 and 60.

During the test

The smear test itself takes about 10 minutes, and the smear taker will advise you how to get into position.

“It’s not painful, and it’s usually not too uncomfortable. A small instrument called a speculum is put into the vagina to allow the smear taker to see the cervix or the neck of the womb and with a brush they’ll take a sample of the cells,” says Dr Flannelly.

After the test

The cells are sent to a laboratory, and you should receive your results within a four-week period.

If your test is normal, you will get a recommendation when your next smear test is due. You can go to the CervicalCheck website and put in your PPS number and your date of birth and it will tell you exactly when your next smear test is due.

“It’s important not just top have one smear test, but to have regular smear tests,” Dr Flannelly says, noting that CervicalCheck offers free tests every three years to women up to the age of 45, and every five years until they turn 60.

If the smear test is abnormal, you’ll be given an appointment to go to the CervicalCheck colposcopy clinics, of which there are 15 around Ireland.

“If it’s a high-grade abnormality, they’ll be seen within four weeks, otherwise they’re seen within eight weeks. If they need a treatment, most treatments are done in the clinic under local anaesthetic, and it’s very effective, reducing your risk of cervical cancer by 90pc.”

Under 25?

Although cervical cancer is rare in women under 25, there have been calls to reduce the starting age for screening, a move some doctors warn could do more harm than good.

“Because the neck of the womb isn’t completely matured, you get a very high rate of abnormal smears. These are what we call false positives,” says Dr Edel McGinnity, a GP in north Dublin.

"When they go for the next part of the assessment, colposcopy, it turns out they don’t have an abnormal cervix. You create this enormous anxiety in people who don’t actually have anything wrong with them.”

Abnormal cells and HPV infections are very common in young women, but as most infections are transient, smears can end up detecting low-grade lesions that will never develop into cancer, leading to over-diagnosis and over-treatment that can be very upsetting for young women.

“Before CervicalCheck came in, we did smears in under 25s, and we used to get huge numbers of abnormal smears. It’s very distressing for a young woman to get this call saying their smear is abnormal, there’s a lot of morbidity and stress associated with it.”

Dr Flannelly argues that the most important thing for women under 25 is to be covered with the HPV vaccination.

“The HPV vaccination program, in combination with cervical screening, is the best possible future for Ireland in terms of trying to make cervical cancer a rare disease,” she says.

“If you are under 25 and you have symptoms, then you absolutely should be checked out. Irrespective of your age and irrespective of your smear results, if you have abnormal vagina bleeding and abnormal vaginal discharge, you should get that checked out and your GP should have a look at your cervix using a speculum.

“They may not take a smear but they may take swabs or something else. Most importantly, they will look at your cervix and tell you if it’s abnormal. If they’re unsure, they will send you to a gynaecology clinic to be checked out.”

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