Those with Compromised Immune Systems
Not Eligible for Cervical Screening – Under 25
Each year in Canada, approximately 1,408 are diagnosed with cervical cancer. Cervical cancer is the 3rd most common female cancer for women aged between 14 and 44 years old in Canada . The number of young women diagnosed will be reducing over the next ten years due to the HPV vaccination program which offers the vaccine to girls under 18 years of age. This program was introduced in 2008 and will help to prevent the majority of cervical cancers .
Those young women who are diagnosed with cervical cancer under the age of 25 often experience typical symptoms prior to diagnosis.
Symptoms of cervical cancer
The most common symptom is:
- Abnormal vaginal bleeding, in between periods, during or after sex.
Other symptoms include:
- Unusual and/or unpleasant vaginal discharge,
- Discomfort or pain during sex
- Lower back pain.
Abnormal vaginal bleeding is quite common, and is usually not serious. If a woman is experiencing symptoms such as abnormal bleeding she does not require a cervical screening test but will need to be examined by her GP and should undergo a direct examination of the cervix in order to rule out the very small chance that a cancer is present.
Vaginal bleeding is extremely common and can be caused by a range of different problems including changes to the cervix (neck of the womb) called ectropion or cervical erosion, changes in hormones due to the contraceptive pill or benign cervical polyps or a sexually transmitted infection such as Chlamydia. The guidelines explain to GPs about the types of questions they need to ask to establish if the symptoms could be related to cervical cancer. A pelvic exam can be done by a GP.
If you are experiencing any of these symptoms or are concerned about any new symptom it is important that you make an appointment to see your GP as soon as possible. Some women find it embarrassing to talk about gynaecological problems. If you feel like this, you are not alone. In a recent survey 80% of women said they would see a doctor for a cold that lasted more than 3 weeks, compared to only 50% if they bled outside of a period . However, your GP will not be embarrassed and they are used to talking about these subjects. Because abnormal bleeding can be a symptom of cervical cancer it is vital you seek some advice from your GP. If you want to you can also take a relative or a friend with you who can support you during your appointment with the GP.
You might also find it helpful to take the Department of Health guidance along with you to discuss with your GP.
Why does cervical screening start at 25?
According to the most recent research, abnormal cervical cells are caused by high risk infection with HPV and are very common in women under 25. They are less common in older women.
A high risk HPV infection has no symptoms so for most women they will be infected and not even know. Whilst a woman has high risk HPV, the infection can cause cells of the cervix to become abnormal (these abnormalities are sometimes called pre-cancerous changes). For most women these cervical abnormalities will clear up by themselves as the body’s own immune system gets rid of the HPV infection . Some women are unable to clear high risk HPV and the abnormal cervical cells caused by this infection could with time turn into cervical cancer.
Because high risk HPV infections are common in young women, screening young women means that there would be a high number of women receiving a positive result indicating that they have abnormal cervical cells that would require further investigation. Most women with high risk HPV will clear the infection within 12 to 18 months and then the cervical abnormalities will go back to normal. But medical experts do not currently have a way to understand which women will be able to clear their abnormalities and which could go on to have cancer. However, they do know that if a woman is older than 25 and abnormal cells have not cleared up on their own, there is a greater need to offer treatment.
So if young women are more likely to have abnormal cells this means these women will be more likely to be sent for treatment to remove the abnormal cells following a screening test.
Treatment for cervical abnormalities has been shown to increase the risk of preterm labour and cause unnecessary anxiety for the woman. [5, 6, 7, and 8].
Diagnosis and treatment for cervical abnormalities has been shown to cause significant psychological trauma and, considering the majority of young women will clear these abnormalities without treatment, it means screening and subsequent treatment for abnormalities could cause more harm than the benefits of screening can provide.
Additionally cervical screening has been shown not to be very effective in young women. In countries where screening started at 20, rates of cervical cancer in women under 25 are not significantly different to countries that start screening at 25 .
The International Agency for Research on Cancer also recommends that women should not start cervical screening before the age of 25.
- Cervical cancer is very rare in women under 25.
- Abnormal vaginal bleeding can be a symptom of cervical cancer – there are guidelines in place for the under 25s with abnormal bleeding. You should see your GP if you are bleeding outside of your period or after sex.
- Cervical screening (the smear test) is not recommended for women under 25.
What will happen during my Cervical Screening?
Having your cervical screening sample taken should only take a matter of minutes. If it is the first time you are attending your screening it can be helpful to find out as much as possible about what will happen beforehand.
You can bring a relative or friend with you if you need support and you can request a female nurse or GP to take the sample. Before the procedure starts the doctor or nurse should explain what is going to happen and answer any questions or concerns you may have.
You will be asked to undress from the waist down and to lie on an examination bed either on your back with your legs bent up or ankles together. Some examination beds may have stirrups on them. If yours does you will need to place your feet in the stirrups. A paper sheet will be placed over the lower half of your body. Your GP/nurse will then insert an instrument called a speculum into your vagina. Some clinicians may use lubricant on the speculum which will make it easier to insert into the vagina. The speculum gently opens your vagina allowing the GP/nurse to see the cervix. The majority of speculums used for screening are made from plastic but occasionally metal ones are used. A specially designed brush is used to take cells from the cervix. The GP/nurse will collect cells from the area of the cervix called the transformation zone. The sampled cells are immersed in a vial of preservative fluid and looked at under the microscope in the laboratory.
In the laboratory, the contents of the vial are spun and treated to remove obscuring material.
For most women, cervical screening is not painful but it may feel a little uncomfortable, therefore, if you experience any pain or other problems please do let the doctor or nurse know. You may have some spotting (very light bleeding) for a day after the procedure.
The best time (if possible) for a cervical screening to be taken is in the middle of your menstrual cycle, halfway between one period and the next. This enables the cytologist to examine the best possible specimen to achieve the best possible report. Most GP surgeries will ask you to book the test so do take you menstrual cycle into account before your book your screening test.
Helpful tips before your cervical screening
For many women the thought of going for cervical screening is often worse than the reality. Do not worry if you feel anxious about having your screening test, this is normal and many women feel like this. It can help to be as informed as possible about what having a cervical screening is like. Make sure you discuss any concerns with your GP or practise nurse.
A few points to remember before going for your screening:
- Do not have sexual intercourse 24 hours before your screening as sperm, spermicidal gel, and lubricants may make it difficult to get a good sample of cells from the cervix.
- If vaginal pessaries have been prescribed to treat an infection then postpone your screening for at least a week after the treatment has finished.
- If you are using a vaginal oestrogen cream for menopause symptoms, do not apply it on the day of your screening.
- Do not douche or use a tampon for at least two days before your screening.
- The sample taker should cover you with a paper towel – however, you can always wear a skirt or bring a scarf if you want to cover yourself up.
- The more relaxed you are, the less discomfort you will feel.
- You can bring a family member or friend with you for moral support.
Testing for HPV
The HPV test is carried out using the same sample of cells taken during a cervical screening test. In the laboratory the cells are analysed for current HPV infection.
The HPV test is important because it identifies women with a high risk type of HPV. If a woman contracts high-risk HPV and this becomes a persistent infection then she has a higher possibility of developing abnormal cells and thus should be monitored more closely to reduce her risk of developing cervical abnormalities and cervical cancer.
The HPV test is carried out using the same sample of cells taken during a cervical screening test. The results of the HPV test combined with cervical screening cytology (examination of the cells under a microscope) enable faster investigation of those at higher risk of developing cervical cancer, and reassurance of those at very low risk. The test can also reduce the number of unnecessary screening appointments and colposcopies among women with borderline/mild cervical screening cytology results or who have been treated for abnormal cells.
In the laboratory, the sample of cells is analysed for high risk HPV infection. If the cells have been infected with HPV, the test will give a positive result for high risk HPV types.
You can read more about HPV testing by downloading our HPV testing factsheet.
You can also order an at home HPV test through Eve kit: https://evekit.com/shop/
Results of Screening
Once your cervical screening has been taken it will be reviewed by specialists at a cytology* department, so, the length of time taken to receive your screening results can vary. Make sure you ask when you have your screening, how and when they will let you know your test result.
If there are no abnormalities seen (the test is ‘negative’) you will be sent a letter confirming the result by your local Health Authority. Sometimes the hospital may contact you with the result. Some GP’s request the patient to ring for their result – do check if they would like you to do this. A negative results means you will be recalled for screening in three or five years dependent on where you live and your age.
If the specialist looking at your cervical screening test feels it would be advisable for you to be reviewed by a hospital doctor then they will inform your GP. In some areas there is an agreement between the hospital and the GP’s surgeries that the woman is informed by letter directly from the hospital, and an appointment is made and enclosed in the same mailing.
More than nine out of ten screening results are negative  and around one in 20 show mild cell changes called mild dyskaryosis. For most women with mild cell changes, the cells will go back to normal without treatment.
One in a 100 test results show moderate cell changes (moderate dyskaryosis) and one in 200 show severe changes (severe dyskaryosis). If your results indicate that you have cell changes, you will be sent for colposcopy to investigate further.
It is extremely rare for cancer to be diagnosed from a cervical screening test. Less than one in a thousand women test results show invasive cancer.
Cervical Screening in Summary
- Remember an abnormal screening result rarely means cancer
- Between 90 and 94% of all screening results are negative
- Having regular cervical screening offers the best protection against developing cervical cancer
- Cervical screening is free and you should talk to your doctor about getting regular screening.
- If you are feeling anxious beforehand ask a member of your family or friend to accompany you. Your doctor or nurse will be happy to talk through any anxieties that you have prior to your cervical screening appointment.