What happens at a cervical screening appointment?

• Invitation
• Taking a sample
• What happens next?
• What is colposcopy?
• When should the cervix be treated?
• What kind of treatment is available?

Invitation for cervical screening

You will receive a letter from your local Primary Care Trust or GP asking you to make an appointment for screening. You can choose whether to have it done at your GP practice or family planning clinic. Most women choose to havethe test done by their GP or practice nurse. You can ask to have yours taken by a female doctor or nurse if you prefer.

Taking a sample

The sample taker should explain the procedure and you should feel able to ask any questions at any time. The doctor or nurse uses an instrument called a speculum to open up the vagina and then a spatula is used to "sweep" around the cervix (neck of the womb) and take a sample of cells from its surface. Most women consider the procedure to be only mildly uncomfortable.

Then the head of the spatula, where the cells are lodged, is broken off into a small glass vial containing preservative fluid, or rinsed directly into the preservative fluid.This is sent to a laboratory for examination under a microscope. Cytology - the study through a microscope of the cells - enables the tests to be grouped into different grades which determine what happens next.

What happens next?

You should receive the result of your test in writing within six weeks from the date of your test.

Most women receive a normal result, which means that the cells were considered to be normal. These women are recalled for another routine test within three to five years. Of 3.1 million women aged 25 to 64 who received a result in 2006-07, 93.5% had a normal result.

Some women receive an abnormal result. This means the laboratory has identified some cell changes which need further investigation. Not all abnormal changes need to be referred for immediate treatment; some may disappear without the need for any treatment. Depending upon the degree of changes, women may be asked to have a repeat test in six or twelve months, or may be referred for colposcopy.

A small proportion of women are asked to return for a second test as the first was considered to be inadequate. This simply means the laboratory was not able to assess the cells to give a result. This may be because of the presence of blood obscuring the cells, or because the sample of cells was too thick or thin. In 2006-07, the percentage of inadequate smears was 4.7%.

What is colposcopy?

Colposcopy is performed by specially trained clinicians at an outpatient appointment. A colposcope - a low-powered microscope - is used to examine the woman's cervix to assess the extent and severity of any problem and to determine appropriate treatment. If necessary, a sample of tissue can be taken from the cervix for diagnosis, and/or the cervix may be treated. Alternatively, women may be asked to have a repeat smear test.

When should the cervix be treated?

Not all grades of abnormality are referred for immediate treatment. Some abnormalities may disappear on their own without treatment. A careful balance has to be reached between referring too many women, with the risk of unnecessary anxiety and over-treatment, and referring too few, with the risk that potentially serious abnormalities go untreated for too long.

What kind of treatment is available?

There are two main methods of treatment. The abnormal cells in the cervix may be destroyed using laser ablation or cold coagulation treatments or the abnormality may be cut away using loop diathermy or laser excision. Loop diathermy, where a thin wire loop cuts through and removes the abnormal area, is the most common treatment.

Hysterectomy is not usually necessary for abnormal cells in the cervix. Treatment aims to preserve a woman's fertility and ability to have children wherever possible. For the few women who have cancer, surgery is the main form of treatment for localised cases. Radiotherapy and chemotherapy may be used for more extensive disease.