Dr Suzy Lishman blogs today about how a five minute test can save you life. Suzy is a consultant histopathologist at Peterborough City Hospital. Her interests include cancer screening, patient safety and public engagement.
If I said there was a free five-minute test to help prevent cancer, would you take it? Almost everyone says ‘yes’ to that, but one in four women in the UK don’t actually do it. I’m talking about the cervical screening test, which is often called a ‘smear’. The smear test has been shown to dramatically reduce your chances of developing cervical cancer, which kills two women in England every day. If all women had regular smear tests, over 80% of cervical cancers would be prevented.
Do you know why cervical screening is often called a smear test? It’s because the old method for taking a sample from the cervix (neck of the womb) involved using a wooden spatula to collect cells, which were smeared onto a glass slide. The slide was then sent to the pathology lab for staining and examination under the microscope. The test was updated several years ago and now involves using a small brush to collect a sample of cells. The head of the brush is immersed in special fluid and sent to the lab, where the fluid, which now contains the cells from the brush, is spun and a sample of the cells placed on a slide. Cervical screening is a more accurate description of the test, and is the term used nowadays.
Whichever method is used, the slide is examined under the microscope by a member of the pathology laboratory staff, which might be a cytoscreener, biomedical scientist or pathologist. They look at the cells and identify any abnormalities, looking particularly for anything that might be a precursor of cancer. These cells have started to change and might develop into cancer if left untreated. By identifying the cells at an early stage, they can be removed before cancer can develop. The earlier the cells are detected, the easier they are to treat.
Women are offered cervical screening free on the NHS every three years from the age of 25 to 50 and every five years after that until the age of 64. Even if you’ve missed a previous appointment it’s not too late to have the test now. There are many reasons why women don’t attend for their cervical screening appointment. Some are embarrassed or afraid that it will hurt. The nurses who do the test are experts at putting you at your ease and they understand that you might be nervous. You could take a friend to wait with you so you don’t change your mind in the waiting room!
Once you’ve had your cervical screening test, you’ll get a result in the post within a couple of weeks. Pathology staff work hard to get the result to you as quickly as possible, but many departments are understaffed. Changes to the way in which cervical samples are tested are also having an effect on pathology departments, with cervical screening being concentrated in a smaller number of bigger labs. This is in preparation for primary HPV testing, which will be introduced in England later this year and involves testing a sample for the presence of the human papilloma virus (HPV), which has been shown to cause almost all cases of cervical cancer. If a sample is negative for the virus, it is highly unlikely that there will be any cellular abnormalities and no further testing is required. If the sample is HPV positive, the cells will be examined under the microscope. This will result in far fewer slides being viewed than in the current system, which means that fewer pathologists will be needed to analyse them. This is good news at a time when only 3% of pathology departments are fully staffed.
When people think of pathology testing, they usually focus on diagnostic tests, which confirm the presence of a disease. Although pathologists spend much of their time on this type of work, they also prevent disease from developing through screening programmes. Cervical screening is just one of several national programmes, which include screening for breast and bowel cancer. It is important to understand that cervical screening is not a test for cancer and does not look for abnormalities elsewhere, such as the womb or ovaries. It aims to detect early abnormalities of the cervix well before cancer can develop. This is why it’s so important that women attend for their cervical screening test regularly. Just five minutes could save your life.