Symptoms, signs and smear tests: what you need to know about cervical cancer

We asked the experts to answer our questions about cancer, HPV and the worries we shouldn't ignore.

While cervical cancer's the 12th most common female cancer in UK, it's the number one cancer in women under 35.

The good news is, a significant number of cervical cancer cases can actually be prevented - by going for your smear tests, which are offered on the NHS every three years to women aged 25-49, and every five years for those aged 50-65.

Smears don't diagnose cancer, per se, but they can detect abnormal cell changes at an early stage which may later - particularly if left untreated - develop into cancer.

Jo’s Cervical Cancer Trust, however, said it was concerned that body image issues, including perception of what is “normal,” could be putting women’s lives in danger as they fail to attend their smear test. One in four eligible women (aged 25-64) do not currently take up their invitation for a smear test, rising to one in three among 25-29 year olds.

It is even as high as one in two in some areas of the UK.

It's now well-documented that human papillomavirus (HPV) plays a major role in cervical cancer. Smoking can also increase a person's risk.

But are you smear savvy? Unsure what's normal and what's not? Here, Ms Deborah Bruce (DB), consultant gynaecologist at London Bridge Hospital and Mrs Nitu Bajekal (NB), consultant gynaecologist at Spire Bushey Hospital, clear up some common queries...

I caught HPV when I was 20. Nine years on, it's always at the back of my mind - am I destined to get cancer?

DB: "No - the risk of developing cervical cancer, even if high-risk HPV positive, is very small. (There are around 140 types of HPV, some called 'high-risk' subtypes - type 16 and 18 are thought to be responsible for causing 70% of cervical cancers. Others are low-risk, which do not cause cancer but are responsible for skin warts, including genital and anal warts.)

"However, there are things you can do to reduce your risk. Ensure you attend your smears. If any abnormalities are found, your sample will be tested for high-risk HPV. Stopping smoking has also been shown to reduce your risk of developing cancer.

"You may also wish to consider obtaining the HPV vaccination course; while not available on the NHS for your age-group, it can be obtained privately. Although not 100% effective, using a barrier method of contraception, such as condoms, can reduce the risk of transmission and re-infection."

The HPV vaccine wasn't around when I was younger, but I've heard some people have it without knowing. Should I be concerned?

DB: "As much as half the population will be infected at some time in their life. In most cases, the virus does no harm because your immune system gets rid of the infection, but in some cases, infection persists and can lead to health problems later.

"Using condoms can help prevent HPV. However, as condoms don't cover the entire genital area and are often put on after sexual contact's begun, they're no guarantee against HPV.

"Smear tests now routinely test for 'high-risk' strains of HPV, if your cervical smear shows mild or borderline changes. You can obtain an HPV assessment privately on all smears, but this will incur a fee.

"If the result's negative, you may have had it in the past but your immune system has cleared the infection. If you are positive, you should be aware that you are at increased risk (albeit small) of developing cervical cancer. You'll be referred for further investigation (and possible treatment) with a colposcopic assessment of the cervix."

After my last smear, my results were 'abnormal' and I was called back for another test. After that, they said nothing needed to be done. I can't help but worry - am I 'high risk' for cancer?

DB: "This could have been a number of things, such as an inadequate sample. Usually, if a mild or borderline abnormality is found, you would have been referred for further investigation with a colposcopic assessment.

"As the repeat test was completely normal, you can be reassured that either no HPV was detected or that your immune system has cleared the infection itself.

"You do, however, still need to attend your regular cervical screening tests every three years, and reduce your risk of developing cervical precancerous changes and contracting HPV in the future by always using condoms, not smoking, and considering obtaining the HPV vaccination."

My mum had cervical cancer. Now I'm so anxious that I might have it but I'm 19 and too young for a smear

DB: "It's quite understandable to be concerned, but there's no known genetic link for cervical cancer (unlike breast and ovarian cancer). However, I would advise that you consider obtaining advice regarding the HPV vaccine, which could reduce your risk of contracting the high-risk cancer-causing HPV.

"The NHS cervical screening programme changed its policy in 2012 to start screening at age 25; I would strongly advise you attend when your time comes."

I've been on the pill for 12 years but I've heard that being on it a long time can increase your risk of cancer. Should I stop taking it?

NB: "It's important to stress that the pill's not associated with an overall increased risk of cancer. Taking the pill for at least three years reduces the risk of ovarian, endometrial and colon cancer for women, compared with non-users.

"There's some evidence to suggest women on the pill for more than 10 years have a four times higher risk of cervical cancer, but that said, the absolute increase in risk is very low and your overall risk is extremely small. The benefits of taking the pill generally outweigh the risks for most women. You could discuss with your doctor to help you consider another form of contraception, such as the coil or implant. What is important, is that you don't stop the pill suddenly and run the risk of unwanted pregnancy.

"Regular smears for all women over 25, whether they use the pill or not, will reduce your risk of getting cervical cancer by 80-90%."

I'm 35 and my periods have recently become extremely heavy. Is this normal?

NB: "Periods are considered heavy if they interfere with daily life. Medically, heavy periods (menorrhagia) can cause anaemia (low-iron levels), making you tired.

"Periods can be heavy when they last longer than normal (usually five to six days) and/or if the flow is very heavy, with clots or flooding. One in five women aged 30-50 is affected and most don't have anything seriously wrong with them. However, a significant number may have polyps or fibroids, which may make periods worse.

"It's important to seek medical advice if your periods have been heavy for the last three months, or if you're feeling particularly tired. Your doctor may recommend blood tests and an ultrasound scan and suggest treatment or referral as appropriate.

"If you're having irregular bleeding, bleeding between your periods or bleeding after intercourse, you should not ignore these signs - see your doctor as soon as possible. Precancerous and cancerous changes are more likely to cause erratic bleeding, rather than just heavy periods."

I've noticed a bit of bloody discharge after sex and between periods. It's never very much, but should I get checked out?

NB: "Post Coital Bleeding (PCB) is something you should not ignore - seek medical advice from your doctor or sexual health clinic. This will allow for a detailed history and examination. You may also be offered a smear if you're aged between 25-64, and haven't had one recently.

"There are several causes of bleeding between periods or after sex, including infection, polyps, atrophic vaginitis, vaginal tears and cervical ectropion. In some situations, bleeding after sex can be a sign of cancer. If you've had regular clear smears though, it's highly unlikely this is the cause, but if you're concerned, see your doctor."

I often get pelvis pain and shooting pains in my cervix. I've read that cervical cancer can't actually cause pain until the late stages, but should I be concerned?

NB: "It's quite normal to have occasional low tummy or pelvic pain and even shooting pains in your vagina and cervix. These are not really signs of cervical cancer.

"It is true that cervical cancer does not usually cause pain until a late stage. However, the most important way you can reduce your risk of cervical cancer is by attending for your regular smear checks. You should also seek advice from a doctor if you are having bleeding after sex or erratic bleeding between your periods."

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