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When should I have a cervical smear sample taken?

The current recommendation in the UK is for women to have their first smear sample on turning 25, and then a smear sample every 3 years until the age of 49, and a smear sample every 5 years until the age of 64 years.

As such, most women will have 12 smears in their lifetime (see table below).

However, the recommendations change based on emerging evidence, adoption of testing technology and the continual assessment of effectiveness of HPV vaccination.

Why are there so many different names for this test?

The technique of detecting abnormalities by taking cells from the cervix was first invented by Dr George Papanicolaou. It is often called the Papanicolaou test, Pap smear, Smear test or simply Smear.

In clinical settings it is often called a Cervical Cytology based on the fact that it was the earliest clinical application of principles of cytology to study a disease and that it assesses cells in the cervix.

What tests can be done on my cervical smear sample?

Cervical smear (or more appropriately ‘Liquid Based Cytology’) is the procedure to collect the cervical material to study.

Once collected, the sample will be sent to the laboratory for one or more of the following tests after a discussion with you:

(1) Traditional cervical smear
Traditional ‘cervical smear’ test looks for evidence of abnormal changes, or potentially abnormal changes to the cells, that have already occurred. The degree of abnormality observed is classified as mild, moderate or severe changes. 

This test does not look for underlying HPV infection. This is not an appropriate test if there are visible abnormal changes on the cervix, which warrants a colposcopy and possible biopsy.

This will be the most appropriate test for you:

• If you have had HR-HPV detected on your recent smear test
• If you have had a negative HR-HPV test and want an additional reassurance 
• If you have on going genital symptoms attributed to cervicitis, and other STI tests have been negative

(2) High risk HPV test
This detects presence of  one or more types of high-risk strains of HPV present in your cervix which can cause abnormal changes in the cervical cells which can progress to form cancer of cervix. Most advanced cervical screening programmes in the world, including NHS, have adopted this as their primary screening test.

(3) Low Risk HPV screen
It is possible to screen for Low Risk types of HPV from the same sample.

How has cervical screening changed, and why is this?

Previously, women would have their cervical smear sample sent for cytology testing as their primary test. If an abnormality was detected, they would then have a HPV test to detect the underlying infection.

Because most abnormalities in the cervix occur because of the HPV infection, and 90% of cervical cancer cases are caused by high-risk HPV, recent changes have been made to the screening process. 

Now, women are tested for HPV first, and if this is detected, the lab will perform a cytology on the smear sample to detect any cell abnormalities which may have developed from HPV infection. This allows women to receive a quicker diagnosis, as well as quicker intervention if necessary.

Who can get the vaccine?

The HPV vaccine is routinely offered to girls and boys aged 12-13 in secondary school, as a preventative measure for those who have not yet been exposed to high-risk types of HPV. It is free on the NHS for those up to the age of 25.

It is also routinely offered to men under 45 who have sex with other men.
Anyone above the age of 18 can receive the HPV vaccine from our clinic, regardless of age, gender or orientation.

Why can’t you have a smear test under the age of 25?

The age limit for UK cervical screening is a highly debated topic, with many calling for the age limit to be lowered. Guidelines advise waiting until the age of 25 before having your first smear test because cervical cancer is very rare in women under 25. On average, there are 0 deaths from cervical cancer in women below this age.

Abnormal cells can develop in the cervix in women under 25, but more often than not, these cells spontaneously resolve themselves without requiring any treatment. Inviting women aged 25 and over is thought to prevent unnecessary and invasive treatments and procedures.

Do I still need a test if I have had the HPV vaccination?

Yes, it’s important to continue to attend regular cervical screenings, as the HPV vaccination does not protect against all types of HPV, and HPV does not cause all types of abnormalities in cervix.

Can I see a female clinician?

Of course, yes. If you would prefer to see a female clinician to take your smear, please let us know at the time of booking.

An aside on the history of cervical smears

In its original form, the sample taken from the cervix was smeared on a glass slide as soon as it was taken before being sent to the laboratory, and hence called ‘cervical smear’ or a ‘smear test’.

Preparing good quality slides required specialist training and reading them manually in the laboratory was a laborious, time consuming process with higher rates of inaccuracy in the results.

That is why you will not be seeing slides being prepared after a smear has been taken these days. Instead the sample is dipped into a liquid container to be studied by automatic analysers in the laboratory, and appropriately called Liquid Based Cytology (LBC).

So although we may still call it cervical smear out of tradition, what we will be doing is Liquid Based Cytology!