What is cervical screening?
Cervical
screening, also known as smear test, is not a test for diagnosing cervical
cancer. It is a test to check the health of the cervix, which is the lower part
of the womb (often called the neck of the womb). For many women, the test
results show that everything is fine. But for around one in 20 women, the test
shows changes in cells. Most of these changes will not lead to cervical cancer.
For women above 30 cervical screening may include testing for the human
papillomavirus (HPV). Certain types of HPV can cause abnormal changes in the
cervix.
The human
papillomavirus (HPV) is a very common infection, and most women get it at some
time in their life. There are many types of HPV, and some types can cause
abnormalities in the cervix. In some cases, these abnormalities may, if left
untreated, go on to develop into cervical cancer. Not all abnormalities
develop into cancer. However, and in many cases, HPV clears up by
itself. Therefore, HPV testing is not undertaken below the age of 30.
HPV is
easily transmitted during intimate sexual contact between partners. This
includes intimate contact between men and women, and between partners of the
same sex. The virus shows no symptoms. This means you or a partner could have
had the virus for many months or years from a previous relationship, without
knowing it.
Why are
women offered cervical screening?
Cervical
cancer can often be prevented. The signs that it may develop can be spotted
early on so it can be stopped before it even gets started.
Many of
those who develop cervical cancer may not have been screened regularly. Not
going for cervical screening is one of the biggest risk factors for developing
cervical cancer.
Should
all women have the test?
The
National Screening Centre invites women born from 1980 onwards. Cervical cancer
is more common if you:
- smoke
- first had sex at an early age
- have had several sexual partners or have had a
sexual partner who has had several other partners or
- take immunosuppressant drugs (for example,
after an organ transplant)
The
incidence in the Maltese Islands has been low, but younger age groups may be sexually
more active. We are already seeing an increase in the incidence of
cervical cancer among the younger ages.
Cervical
screening under the age of 25 is not recommended and may do more harm than
good.
Ask your
family doctor for advice if you:
- have had a hysterectomy
- have never had sex with a man or woman or
- you are not sure whether you still need to be
tested
What is
the Cervical Cancer Screening Programme?
The
programme makes sure that if you are aged between 25 and 41, you will
automatically receive an invitation. We will get your name from national
datasets. Your personal information - such as your name, contact details, age,
gender, ID number, results of your screening tests, and the name of your doctor
is protected by law under the Malta Data Protection Act. (This means that it is
important that the National Screening Centre always has your correct name and
address)
After
your first cervical screen, you will receive invitations every three years.
When you reach the age of 50 you will be invited every 5 years.
Who will
carry out my test?
A doctor
will carry out your test. If you would prefer to see a female member of staff,
or would like someone with you, please ask when you schedule your appointment.
We will
ask you to undress from the waist down, but if you wear a full skirt you will
not have to remove it.
What
happens during the test?
The test
takes just a few minutes. The doctor or nurse will ask you to lie down on a
couch. They will then gently put a small instrument, called a speculum, into
your vagina to hold it open. Then, the doctor will wipe a small brush-like
device over the cervix to pick up some cells. They will put these cells into a
small container of liquid and the specimen is sent to lab where the cells are transferred
onto a slide and examined under a microscope.
You might
experience some discomfort or pain – try to relax by taking slow, deep breaths
as it may hurt more if you are tense. If it is painful, tell the doctor or
nurse straightaway as they may be able to reduce your discomfort.
We are
starting to introduce HPV testing as part of the cervical screening programme.
HPV can cause abnormal changes in the cervix. If your screening result shows
borderline cell changes or mild abnormalities (known as mild or low-grade
dyskaryosis), an HPV test may be carried out on the sample of your cells taken
during screening. This will help us decide if you need any further
investigation, or if you can simply go back to routine screening in three- or
five-years’ time (depending on your age).
When
should I have my screening?
You
should not be tested during your period so try to make sure you get an
appointment before or after your period is due. The best time is in the middle
of your cycle.
Can I
have sex before the test?
If you
use a spermicide, a barrier method of contraception, or a lubricant jelly, you
should not use these for 24 hours before the test as the chemicals they contain
may affect the test.
When do I
get my results?
When you
have the test, the doctor or nurse will tell you how, where, and approximately
when you will get your results. Make sure you have received this information
before you leave the surgery or clinic.
What
about my HPV results?
If you
have a screening result showing borderline cell changes or mild abnormalities,
then your screening sample may be tested for HPV. If your sample is tested for
HPV, then you will get this result at the same time as your screening result.
How
reliable is cervical screening?
Early
detection and treatment can prevent around 75% of cancers developing but, like
other screening tests, it is not perfect.
It may
not always detect early cell changes that may lead to cancer. Abnormal cells on
your slide may not be recognised because:
- sometimes they do not look much different
from normal cells
- there may be very few abnormal cells on the
slide; or
- the person reading your slide may miss the
abnormality (this happens occasionally, no matter how experienced the
reader is).
About one
in 20 tests need to be taken again because:
- you may have an infection or inflammation which
needs treating before a clear slide can be made
- the cervical cells on your slide may have been
hidden by blood or mucus
- there may not have been enough cervical cells
on your slide to give an accurate assessment
- your sample may not have been properly
prepared; or
- the sample bottle is damaged
Screening
is not used to investigate cervical symptoms. If you have any unusual symptoms,
such as bleeding after sex or between periods, you should see your doctor as
soon as possible.
What does
it mean if I am called back for another screening test?
This
usually means that your sample did not show up clearly, so we need to take
another one. This is called an ‘inadequate result’.
On the
other hand, screening may have found some mild changes in the cells of the
cervix. If abnormal changes (known as dyskaryosis) are detected, you will have
what is called an ‘abnormal result’. If you have borderline or mild changes
found at screening, you may be asked to come back again after some months for a
repeat test. This is routine for any woman with borderline or mild changes if
their screening sample has not been tested for HPV. Your result letter will let
you know if you need to come back for another screening test.
Can
anything be done about abnormal changes?
Yes. Your
doctor or nurse will explain what needs to be done. They may simply ask you to
come back for more cervical screening tests because the abnormal cells may
return to normal by themselves.
However,
they may ask you to go to a clinic or hospital for a closer examination which
is called ‘colposcopy’.
Colposcopy
is a minor procedure and is usually done in a walk-in clinic. This means you
will not have to stay overnight.
Can
cervical screening prevent cancer?
Yes.
Regular cervical screening is the best way to detect changes to the cervix
before cancer develops. Early detection and treatment can prevent cancer
developing in around 75% of cases. Screening can also find cervical cancer
early on when treatment is more likely to be effective.
What
happens to my screening sample once it has been looked at?
The
laboratory that looks at your sample will keep it for at least 10 years. They
can then compare your latest result with the ones you have had before. This is
to make sure that you get any treatment you may need. They may review all
screening records, including your sample, as part of our aim to offer a quality
service and to help increase the expertise of specialist staff. This means that
staff who work elsewhere in the health service may need to see your records.
To help
you decide whether to come for cervical screening, the main benefits and
difficulties of cervical screening are explained below.
- Cervical screening reduces the risk of
developing cervical cancer.
- Due to cervical screening, cervical cancer is
now an uncommon disease in this country.
- Cervical cancer rates in many countries have
halved since the 1980s, largely due to most women regularly having
cervical screening.
- In around one in 20 tests, the cells cannot be
seen properly under the microscope and the test must be taken again.
- The test can show mild abnormalities in
cervical cells which would have cleared up on their own, and women would
never have known about them if they had not been for screening. It is not
yet clear which minor abnormalities will develop into cancer and which
will not. Many women worry when a minor abnormality is found.
- Cervical screening does not pick up every
abnormality of the cervix.
- Regular cervical screening can prevent around
75% of cervical cancers developing, but it does not prevent every case.
- Some women find having the test an unpleasant
experience.
Whom can I contact if I have any questions about cervical screening?
If you have any questions or difficulties regarding cervical cancer
screening, one may contact the Screening Centre on
Telephone: 2122 7470/1 between 8.30am – 2.45pm
Facebook: National Screening Centre
Address: 17, Lascaris
Wharf, Valletta, VLT 1921