Thursday 22 February 2018

Do I need a smear test if I get the HPV vaccine?

Q: My GP recently advised me to book a smear test. I just had my 25th birthday. Is this really necessary and what exactly does the test involve? My younger sister was recently given a vaccine

Dr Nina Byrnes
Dr Nina Byrnes

Nina Byrnes

Cervical cancer is the second most common cause of female cancer worldwide with about 500,000 new cases diagnosed per year.

In Ireland, there are about 300 new cases diagnosed annually and it causes about 90 deaths.

The cervix is the neck of the womb. Cancer of the cervix is slow growing and takes many years to develop. The cells of the cervix pass through a number of stages of inflammation before becoming cancerous.

If changes are picked up at this early stage they can be treated, making this potentially deadly disease preventable.

The screening test for changes in the cervix is called a smear test.

Many women are fearful of smears but there is no need to be. It simply involves taking a brushing of cells from the neck of the womb. A small plastic device called a speculum is inserted into the vagina to open it slightly and allow the smear taker to view the cervix. The insertion of a speculum can be associated with a feeling of pressure in the vagina but it should not be painful. The taking of the smear itself involves rotating a small soft brush in the cervix and is completely painless. A smear is usually done in a GP surgery or clinic and you can return to normal activity immediately afterwards.

 Cervical check is our national screening programme for cervical cancer. It invites all women aged 25 to 60 to attend their GP or clinic for a free smear test. Screening in women under the age of 25 is not considered routinely beneficial.

The cervix may still be maturing and changing at this stage and so screening may result in false positive results that can lead to unnecessary investigation and treatment. If you have had normal smears all your life it is unlikely that further screening is required beyond 60 years of age.

In those who have had abnormal smears or required treatment, screening may continue beyond this.

An abnormal smear does not mean that you have cancer. Some of the earliest changes resolve alone and simply require follow-up with a smear six months later.

More advanced pre-cancerous change are referred to hospital for a test called a colposcopy. This involves staining the cells of the cervix and looking at them directly. Abnormal cells can be removed. This procedure is called a LLETZ procedure and is done in a hospital outpatients’ clinic. Smears are recommended every three years, from the age of 25 to 44 and every five years from 45 to 60. Cervical cancer doesn't usually cause any symptoms until it is very advanced and this is why screening is so important.

 Three-yearly screening in those up to age 40 prevents 41pc of cancers and five-yearly screening in those over this prevents 63pc of cancers. If you have any unusual symptoms or have had abnormal results you may require earlier smears and closer follow up.

If you have ever been sexually active you require regular cervical screening from the age of 25. Although the chance of developing cervical cancer is very low if you have never been sexually active, it is not impossible, and thus many doctors recommend a one-off smear in this group. Gay women also require regular cervical screening.

Cervical cancer is more common in heterosexual women, those who have had multiple sexual partners, smokers, those infected with the HPV virus, and those whose immune systems are suppressed due to other diseases or medications. There is a slight increased risk in women who use the oral contraceptive pill.

The Human Papilloma Virus (HPV) is particularly associated with the development of cervical cancer. This virus is extremely common and most people who have been sexually active will have been exposed at some stage. There are about 100 strains of HPV – some of these are associated with the development of genital warts while others cause changes in the cervix. It is felt that types 16 and 18 cause 70pc of all cervical cancers.

If a smear has been abnormal and colposcopy is required, HPV testing may be done as part of this process.

Those who test positive for HPV will require closer follow-up. The HPV vaccine is offered to all girls in 1st year in secondary school as part of our National Immunisation Programme.

There is also a catch-up programme in place for girls in 6th year up until September 2014.

This vaccine protects against strains 16 and 18 of HPV along with other strains associated with genital warts. It is given in 1st year as it is most effective when administered prior to the onset of sexual activity.

This is the vaccine your sister most likely received. Three injections are given over a period of six months. The HPV vaccine should reduce the incidence of cervical cancer but it is not 100pc effective and cervical smears are still required.

The important point to remember is that smears are a free, straightforward, simple and painless procedure that can save your life. Your GP was right to advise you to book one. Don't delay.

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