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What is a smear test?

'Smear test' is a commonly-used term for cervical screening, also known as a 'pap test' or 'pap smear'. It's a quick process designed to collect cells from the outer opening of your cervix, at the entrance to your uterus. These cells are then tested for any changes or abnormalities.

All women who live in Ireland and are registered on the Cervical Screening Register (CRS) are sent regular postal invitations to undergo smear tests after the age of 25. Your details should be automatically passed to the CRS when you come of age, or you can register yourself at any time. You can then book an appointment for a cervical screening with a registered GP or nurse through CervicalCheck, Ireland’s national screening programme.

It’s important to remember, you do not need an invitation to make an appointment for a smear test. You also do not have to have a smear test - it's not mandatory, but is generally considered advisable.

Do smear tests detect cancer?

A smear test is not a test for cervical cancer. However, a smear test can prevent the development of cervical cancer by identifying any changes or abnormalities in cells early on, which could potentially become cancerous if ignored. This does not mean that all abnormal cells will become cancerous.

How is a smear test done?

A smear test will be conducted by a doctor or a trained nurse and should only last between 5-10 minutes. Your doctor or nurse will start by explaining exactly what the process entails, and you may ask questions before the procedure begins to make sure you understand it completely and are not worried or nervous.

Your doctor or nurse will ask you to remove your clothing from the waist down and to lie back on an examination bed, usually with your feet up. You will be covered with a sterile paper sheet from the waist down; there is no need to be embarrassed during the process, as your doctor or nurse will have done smear tests many times before. If it makes you feel more comfortable, you may bring a friend or family member with you, or request that a female doctor or nurse carries out the test.

In order to make it easier to see and reach your cervix, your doctor or nurse will insert an instrument called a speculum into your vagina. This will be done carefully and with lubrication. The speculum will slowly and gently open your vagina, so that your doctor can quickly examine your cervix, before using a tiny brush to swab cells from it. This should be over very quickly, and the speculum will be removed. You can then get dressed, and the collected cells will be marked and sent away for testing.

Is a smear test painful?

A smear test is usually more uncomfortable than painful, but some women do experience pain during or for a short while after the test. It's important to breathe deeply and relax; your doctor or nurse will generally talk you through the process as it is being conducted and reassure you. It doesn't take very long and is much easier to do properly if you are not too tense, so try and stay as relaxed as possible.

Any mild pain or discomfort you do experience after a smear test should fade and stop very quickly afterwards. If you do experience pain or bleeding after your test, please contact your GP as this could be a symptom of something else.

When do I need a smear test?

When you reach the age of 25, CervicalCheck will send you a letter asking you to make an appointment for a cervical screening. This letter may arrive up to six months before your 25th birthday, and should contain more information about cervical screening, instructions on how to make an appointment and with whom.

Ideally, you should have your test in the middle of your menstrual cycle and not while actually menstruating. Do not use spermicides or barrier contraception within a 24-hour period before being tested, as the chemicals in these forms of contraception can affect your test results.

How often should I have a smear test?

Women are invited to have regular smear tests between the ages of 25-65. As long as you are registered with the CRS and they have your correct details, you should receive reminders:

• every three years between the ages of 25-44 

• every five years between the ages of 45-60

If you are over 60, unless you have not had a smear test in the last fifteen years or have recently received abnormal results, you probably will not need another smear test. The likelihood of abnormal or cancerous cells developing in women over 60 who have had normal results for years is extremely low. If you have had abnormal results within the last three tests, you may continue to have tests until the cells become normal again.

Who doesn't need a smear test?

There are a lot of misconceptions about smear tests, including the myth that lesbians do not need smear tests. All women who are or have at some point been sexually active are recommended to have regular smear tests. If you have never been sexually active, your chances of developing abnormal cells are very low and you may choose not to have the test.

Some women who have had hysterectomies where the cervix was left intact are also still at risk of developing abnormal cells and will be invited to continue having smear tests.

However, it is not usually recommended to have a cervical screening if you are pregnant or if you are already experiencing symptoms of cervical cancer. If you are not sure whether you need a smear test, please contact your GP or the National Cervical Screening Programme.

Why are smear tests important?

In Ireland, there is an average of 180 new cases of cervical cancer diagnosed every year (Cervical Cancer and Screening).Regular smear tests can identify early signs of cancer, which means that it can be treated in a very early stage, which gives you a much better chance of recovering completely.

Cervical cancer is not necessarily fatal, but in a small percentage of cases it is very dangerous and therefore stopping it from developing at all is very important. Smear tests have been shown to reduce the number of cases of cervical cancer.

Why aren't women under 25 tested?

It's very difficult to tell the difference between changes caused by normal cell development and changes caused by abnormal cells in younger women, which can lead to a lot of confusion. Also, women under 25 are generally considered to have a much lower risk of developing cervical cancer than older women.

What do my smear test results mean?

Your results will be sent to the doctor or nurse who took your smear. You will receive a letter from CervicalCheck advising you that your results have arrived and giving a recommendation on what to do next.

Your cell sample will have been tested for abnormal cells, otherwise known as a cytology test. Your results will generally be in one of three categories:

• Negative

• Inadequate

• Abnormal

Negative results mean your cells are normal and you don't need to do anything until your next test is scheduled.

Inadequate results indicate that the test has failed to be conclusive, usually because not enough cells were taken at your smear test. You may need to re-schedule a smear test – your results letter should inform you of what to do next. Inadequate results can also indicate an infection, which may need treating before another test is performed.

Abnormal results show that you have dyskaryosis, meaning that abnormal cell changes have taken place. These can be either:

• low-grade / borderline changes

• high-grade / moderate or severe changes

Low-grade changes mean that your abnormal cell changes are not far off normal and may go away on their own. Your cell sample will also be tested for HPV, the human papilloma virus, as this can cause abnormal cell changes. HPV tests are very straightforward: either positive or negative. If you do test positive for HPV, it can be one of many different types of HPV, not all of which are necessarily dangerous. If you test positive for a high-risk strain of HPV, you will need a colposcopy.

If you have low-grade changes but test negative for HPV, your risk of developing cervical cancer or further complications is very low, and you can relax until your next cervical screening.

High-grade changes will also mean you need a colposcopy. A small tissue sample, or biopsy, will be taken from your cervix, in much the same way as your original smear test was conducted. This sample will then be examined under a microscope called a colposcope. You won't need an additional HPV test.

How reliable are smear test results?

Smear test results are not 100% accurate, and do not rule out all the possible causes of cervical cancer.

If my smear results are abnormal, do I have cervical cancer?

Abnormal results don't mean that you have cancer. Abnormal test results mean that some of the cell changes in your cervix are unusual, and could require treatment to prevent them from becoming cancerous. Often, abnormal cells return to normal without treatment. Sometimes, depending on your general health and medical history, your GP may recommend removing the abnormal cells. He or she will discuss further treatment with you if it's necessary.

More information regarding cervical screening in Ireland can be here. If you have any further questions or queries please get in touch with either your doctor or practice nurse.







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