A cervical smear test is a screening test to detect abnormal changes in the cells of the cervix that if not treated could develop into cancer. Treatment at an early abnormal stage is usually very effective. A cervical smear is taken while a women is lying down or on her side. A speculum is placed in the vagina so the cervix can be seen. Some cells are gently taken from the cervix with a small spatula or tiny brush. The cells are then smeared on to a slide, or placed in liquid, and sent to the laboratory for testing. Having a cervical smear may be slightly uncomfortable but is not painful for most women.

Who needs to have a cervical smear?

Women aged between 20 and 69 should have regular three yearly cervical smears. Cervical smears are not neccessary for women who have never engaged in any type of sexual activity.

When should I start having smears and when should I stop?

It is recommended that you should start having regular smears after you turn 20. The normal screening interval is every three years but if it is your first smear or you haven't has a smear for five years you will need to have another one in a year's time. If you have always had normal smear results you can stop having smears at age 70.

How often do I need a smear?

If you have never had a smear or if you have not had one for 5 years or more your first smear should be followed by another one a year later. If both of those are normal you should then have one every three years. If you have ever had an abnormal smear, you will need to have smears more frequently. Your smear taker can advise you how often you should have them.

Where can I go for a smear?

There are a number of places that you can go for a smear and it is important that you feel comfortable with your choice of smeartaker. Medical centres, health services, Family Planning Centres and some clinics will provide a smear taking service. Some of these services may not be available where you live. If you want to find out about the options in your area please call 0800 729 729 to speak to someone at your local National Cervical Screening Programme site. They will be able to tell you about the smear takers in your area.

Do I need a smear if I have had a hysterectomy?

If you have had a total hysterectomy, that means the removal of the uterus and cervix, you do not usually need to continue to have smears unless you had a history of abnormal smears. If you had abnormal smears before surgery or abnormalities were found at the time of your surgery you will need to go on having smears from the top of your vagina (vaginal vault smears). If you are not sure about the type of hysterectomy you had it is recommended that you talk to your doctor.

What is HPV?

HPV (human papillomavirus) is the name of a group of viruses that can infect different areas of the body. There are over 200 types of HPV and about 40 of them can affect the genital area. HPV viruses are divided into 'low' and 'high risk' types. ‘Low risk’ types are mainly found in external genital warts and ‘high risk’ types cause changes to the cells of the cervix. HPV is a common sexually transmitted infection, affecting an estimated 80 per cent of sexually active women at some point in their lives, and probably as many men. Most cervical cell changes caused by HPV infection will clear on their own within months of the infection, however may take up to two years. Some HPV infections may remain, and women with a persistent infection (one which does not clear on its own) with a high risk HPV type are at risk of cervical cancer. There is no treatment for persistent HPV infection itself, however there is treatment for the abnormal cervical cell changes that HPV can cause.

What is cancer?

Cancer is a general term used to describe cells that grow in an uncontrolled way. There are over 100 different cancers. Cancers occur in different parts of the body and the symptoms caused, their seriousness and treatment vary. This is one of the reasons there is no simple 'cure' for cancer.

When cells become abnormal, they begin to divide in an uncontrolled way. As they multiply these cells form a mass called a tumour. A benign tumour does not spread to other parts of the body. A malignant tumour invades surrounding tissue and can infiltrate and spread through the blood and lymphatic vessels to other areas of the body.

What causes cancer?

Just as there are many types of cancer, so there are many causes or combination of causes for different cancers. Many causes are unknown. What causes one type of cancer may not cause another. Smoking is a major cause of lung cancer and is linked to some other cancers. Other connections established through research link ultraviolet light to skin cancer, and a low fibre diet to bowel cancer.
Cancers may grow slowly at first and usually many years pass between exposure to carcinogen (cancer-causing agent) and the development of a cancer serious enough to cause symptoms. Although the exact mechanism within a cell which causes it to become cancerous is not fully understood, it is unlikely that exposure to a single carcinogen is responsible. Some carcinogens are thought to be initiators, which trigger the cancer process; others may be promoters, promoting the growth of cancer cells. Usually there has to be a combination of these and some predisposing factors such as a family history of cancer or a suppressessed immune system, before a cancer grows.

What is cancer of the cervix?

There are two main types of cervical cancer: squamous cell cancer and adenocarcinoma (glandular cell cancer). Squamous cell cancer is the most common form of cervical cancer. It usually arises in the transformation zone of the cervix where the squamous cells meet the glandular cells that line the cervical canal . Adenocarcinoma is less common and is found in the glandular cells which line the inside of the cervix and cervical canal.

Cervical cancer usually develops very slowly, taking up to ten or fifteen years to develop. It starts when some cells on the surface of the cervix change and become abnormal, usually due to sexually transmitted HPV infection. These abnormal cells may return to normal by themselves, however if the HPV infection is persistant for some time they may develop into more severe abnormalities or into cancer if not treated.

Where is the cervix and what is it like?

Pelvic bones encircle and protect the uterus (womb), bladder and rectum in the lower abdomen. The lower narrow part of the uterus protrudes into the vagina and is called the cervix. It sits at the top of the vagina, firm and fleshy, and is about two to three centimetres across. It has thick walls with a central passageway or canal connecting the body of the uterus with the vagina below.

The outer part of the cervix can be examined directly. The cervix is about 7.5 centimetres at the top of the vagina. A health professional doing an internal examination can reach it with the tip of the fingers. It is possible for a woman to feel her own cervix this way. If she inserts her fingers into her vagina she will feel the flexible walls of the vagina around them. At the top of the vagina is something that feels a bit like the end of a nose – firm but not hard and quite mobile. This is the cervix.

A uterus is usually positioned forward (anteverted), but can be central, or towards the back (retroverted). If the uterus is anteverted, the cervix may be angled more towards the back of the top of the vagina; if it is in mid position it points straight down the vagina; and if the uterus is retroverted it points forward. These positions are all normal.

From glands both on its surface and inside, the cervix produces cervical mucus, sticky secretions that are noticeable only at times when they naturally increase - at ovulation (the middle of the menstrual cycle), or during pregnancy.

Why should a women have a cervical smear?

Having regular cervical smears is a woman's best protection against the most common form of cervical cancer. Cervical screening is unique in that it can detect abnormal changes in the squamous cells of the cervix before they develop into cancer.

Cervical cancer is one of the most preventable of all cancers.

Persistent low grade and high grade abnormalities can be treated, ie, the abnormal area is removed. Treatment at this stage is very effective.

About 200 New Zealand women develop cervical cancer every year and about 60 - 70 women die from it. Those women who have never had a cervical smear or have not been adequately followed up are the most likely to develop cervical cancer. Women who have not had a smear test in the last five years are also at increased risk.

Do lesbians need cervical smears?

Research shows that lesbians do develop cervical abnormalities and so need to have regular smears.

What is the best time to have a smear done?

If a woman still has periods the best time to have a routine cervical smear is at ovulation, the middle of the monthly cycle. A day or two before or after a period should be avoided as there may be menstrual blood present.

If a woman no longer has periods any time is suitable for the smear to be taken.

What if a women is pregnant?

Smears should be taken as per the cervical screening guidelines. Cervical smears and colposcopy are not contraindicated in preganancy, however there is no need for a woman who is pregnant or post-natal to have a cervical smear unless she is due for one according to the cervical screening recommendations. If she does need one there are usually no contraindications to having one performed.

Who can take a smear test?

A doctor, midwife or nurse who has completed recognised smear taker training can take a smear. Smear-taking should be provided in a way that is acceptable to women, including by a smear taker of their choice. This includes access to a female smear taker of their cultural group if they wish.

Women can contact their regional cervical screening programme for the names of smear taker service providers in their area by freephone calling 0800 729 729.

How is the cervical smear done?

Before you have a cervical smear, your smear taker will usually tell you how it is done. A woman will usually be asked to take off her lower clothing (but may leave on her petticoat and skirt if they are loose fitting) and lie on her back or side on a couch or bed. The smear taker should allow her to choose the position comfortable for her.

Once she is lying down, a warmed metal or plastic instrument called a speculum is placed in the vagina, so the cervix, at the top of the vagina, can be seen. As the vaginal wall is usually collapsed like a closed umbrella, the speculum is used to hold the walls of the vagina apart so the cervix can be seen. The cervix is inspected visually and any obvious changes are noted.

Some cells are then gently taken from the cervix with a special broom or spatula and sometimes a brush. The cells are then smeared onto a slide, fixed with a solution or spray, and sent to a laboratory to be examined under a microscope for any abnormality. For preparation of smears using liquid based cytology the brush with cervical cells is placed in liquid for sending to the laboratory. The cervical smear takes only a few minutes to do. It may be slightly uncomfortable but it is unusual for it to hurt. It may be more uncomfortable or even painful if there is an infection present, so this should be discussed with your smear taker. A woman who thinks she may be tense or nervous may find it helpful to practise some relaxation techniques beforehand such as controlled breathing.

How will I get my results?

The laboratory will send your results to your smear taker within three weeks. It is important to talk with your smear taker when you have your smear about how you will get your result. You can ask your smear taker to inform you of the result even if it is normal. The first time your result is sent to the NCSP-Register, the National Cervical Screening Programme will send you a letter with that result. It will also write to you if, in future, you have any abnormal results.

What is the NCSP-Register?

The NCSP-Register is an information system that is managed by the National Screening Unit in the Ministry of Health, who operate the National Cervical Screening Programme.

Your personal, contact, cervical and treatment details are stored on the NCSP Register and used to correctly identify you, determine when you need to have your next smear or if follow-up is required and to write to you to remind you if you are overdue for a smear or need follow-up.

Should the result go to the National Cervical Screening Programme-Register?

All results are forwarded to the Register unless a woman withdraws from the Programme. When a woman withdraws from the programme by filling in a 'Withdraw from the Programme' form or writing to the Programme, she and her smear taker are responsible for her cervical screening. The Programme will not follow up her smear results or track her smear history.

Download a 'withdraw from the programme form'

What percentage of smear results are normal?

Over eighty percent of smear results are normal. Of the other 20 percent, 13 percent show either inflammation or infection and the remainder either atypical or abnormal cells.

Why should a repeat smear be necessary?

A repeat smear is necessary for unsatisfactory smears, that is a smear that cannot be 'read' due to not enough cells on the slide or they were damaged or hidden eg by blood or mucous. It is recommended that a repeat smear is done within three months.

Why would a women need a smear more frequently than every three years?

A woman may be asked to have a smear at a shorter interval than three years if it is her first smear or she has not had a smear test for over five years. This is to reduce the chances of any abnormal cells being missed. If a woman has an unsatisfactory smear or an abnormal result, she will be asked to come back sooner. Her smear taker or doctor will advise her when to have her next smear or if she needs further checks. Women who are treated for a high grade abnormality are advised to have a cervical smear test each year.

Some women who have a lowered immune sytem and may be at higher risk of developing cervical cell abnormalities may be advised to have cervical smear tests each year.

Will other checks be done?

This depends on the reason for your visit. Swabs may be taken if there is an indication that an infection might be present or if you have requested a full health or sexual health check.

Does a cervical smear test show up other infections?

Having a smear test may identify the presence or absence of infections including those that are sexually transmitted. This information is included in the result given to the woman by her smeartaker.

What if the result shows infection or inflammation?

It is not uncommon for the cervix to be inflamed. This is sometimes due to infection but often it is just a normal finding in sexually active women. If there is an infection, the report may give cause, eg, thrush. Sometimes other tests are needed, such as a vaginal swab. Some infections clear up without treatment. For others, a woman needs to take medication. This needs to be discussed with your smear taker.

What does it mean when a result is not normal?

An abnormal result hardly ever means cancer. An abnormal result means some of the cells differed in some way from normal cervical cells. Cell changes are classified as low grade, high grade, glandular cell changes and cancer.

Low grade changes mean that some cells are mildly abnormal, usually due to presence of HPV (human papillomavirus). Over half of these changes return to normal by themselves. In some cases they may stay the same or develop into high grade changes. If the changes remain after a repeat smear your smear taker will refer you to a gynaecologist for a colposcopy assessment of your cervix.

High grade changesSome cells appear to have more serious changes. There is a greater risk that abnormal cells, if not treated, could develop into cervical cancer. You will be referred for colposcopy within a few weeks. These cell changes are called CIN2/3.

Glandular cell changes are detected on occasions and these changes also mean a referral for colposcopy. If your smear test shows any changes that suggest cervical cancer, you will be referred immediately to a specialist.

What are CIN 1, 2, 3 (Cervical Intraepihelial Neoplasia)?

These are grades of abnormal changes in the surface cells of the cervix. There are mild (low grade) or more severe (high grade) changes that are not cancer but some could develop into cancer if not treated.

These abnormal changes are also called:

Low-grade Squamous Intraepitheilial Lesion (LSIL) are CIN 1 (mild) changes related to the human papillomavirus (HPV) infection. These changes need careful follow up but may not need treatment.
High-grade Squamous Intraepitheilial Lesion (HSIL) covers both CIN 2 (moderate) and CIN 3 (serious) changes which may lead to cancer if not treated.

What happens if cell abnormalities are found?

If mild changes are found, a woman will be asked to have smears more often to see if the changes persist.

Moderate to severe changes require referral to a specialist who will follow up with another examination called a colposcopy, when the cervix is looked at with a special microscope called a colposcope.

Treatment depends on the type of abnormality assessed at colposcopy, the woman's age and individual circumstances such as pregnancy. The NCSP has guidelines for the management of abnormal cervical smears developed with a group of specialist doctors.

What if human papillomavirus (HPV) infection is indicated on the result?

HPV (human papillomavirus) infection is a common sexually transmitted viral infection affecting an estimated 80% of sexually active women at some point in their lives, and probably as many men. Most infections are transient with the bodies immune system clearing the infection by itself. There are many types of HPV and only a few "high risk" types can lead to abnormal precancerous cells which may or may not progress to invasive cervical cancer. Only women with a persistent infection (one which does not clear on its own) with a "high risk" HPV type are at risk of cervical cancer, if the abnormal cells (pre-cancer) are not detected by screening and removed at colposcopy. There is no treatment for persistent HPV infection itself, however, there is treatment for precancerous cervical cell changes that HPV can cause.

Are smear results always accurate?

The cervical smear test is a screening test not a diagnostic test. This means it tells whether a woman is unlikely to have abnormal changes in the cervix (normal result), or is likely to have abnormal cells (abnormal result). A cervical smear test is a very good screening tool, but occasionally abnormal cells can be missed. This can happen because the smear did not contain any abnormal cells or they were hidden by blood or mucous so they could not be seen under the microscope. Some cells with slight changes are also hard to interpret as normal or abnormal. If abnormal cells are "missed" this is called a false negative result. There is a false negative rate of up to 20%, however as cervical cell changes happen very slowly, it is likely that any abnormalities will be picked up at the next cervical smear test in three years time. This is why it is important that women have regular smear tests as it is still the best method of detecting abnormalities.

What is colposcopy?

Colposcopy is a specialist outpatient examination using a small microscope (like binoculars on a stand) called a colposcope. A liquid is wiped on the cervix so that any areas with abnormal cells show up. A colposcope allows the specialist to see any abnormality in the cervix and vagina and to take a small sample of tissue from any area that looks abnormal. This sample is called a biopsy, which is sent to the laboratory for examination under a microscope. The colposcopy itself usually takes ten minutes, the entire appointment time taking 20 or 30 minutes depending on whether it is a first appointment or not.

How is a colposcopy done?

A woman will be asked to lie on a reclining chair or the end of a special bed with her legs raised and supported by leg rests. She will be covered with a sheet. In the same way as during the smear test, the doctor will use a speculum to gently hold the walls of the vagina open. A light is shone onto the cervix and the doctor looks through the colposcope which magnifies the cervix so it can be examined in more detail. In some clinics a woman may be able to view the procedure on a television monitor. Her cervix and vagina will be painted with a weak vinegar-like solution. This alters the abnormal areas that will then look white and so can be seen for the specialist to take a tissue sample (biopsy).

Does a colposcopy hurt?

An examination by colposcopy can be slightly uncomfortable but it is not usually painful. If a biopsy is taken, a woman may feel a slight pinch or brief pain at the time. If a woman wishes, she is able to take a support person to the appointment.An examination by colposcopy can be slightly uncomfortable but it is not usually painful. If a biopsy is taken, a woman may feel a slight pinch or brief pain at the time. If a woman wishes, she is able to take a support person to the appointment.

What follow-up will be needed?

The colposcopist will advise whether the abnormal cells were treated at the time of the biopsy or if further treatment will be required. After treatment a woman will see her specialist for a check colposcopy within six months to check that all abnormal tissue has been removed. A cervical smear is usually taken at the same time. The woman will usually see her smear taker for ongoing follow up after that. She will need more regular smear tests as recommended in the NCSP guidelines. If she has a hysterectomy for cervical abnormalities, she will need to continue having smear tests taken from the top of the vagina - vault smears. If no treatment is needed, the specialist may ask the woman to return for a further colposcopy or may refer her back to her usual smear-taker for her next smear.

What does treatment do?

Treatment will remove abnormal cells over 90% of the time. Occassionally further treatments may be needed. Women who have had treatment for abnormal cells hardly ever develop cancer of the cervix in the future, however, it is important that you have routine follow-up as recommended by your specialist or smear taker.

What sort of treatments are there?

The treatment for cervical abnormalities involves removing or destroying the abnormal cells. The type of treatment used will take into account the sort of abnormality and where is is on the cervix. Treatment methods include:

LLETZ treatment (Large Loop Excision of the Transformation Zone) - this treatment uses an electrical wire loop to remove abnormal cervical cells under local anaesthetic by colposcopic vision (magnified). The instrument used stops bleeding as the tissue is removed. The removed tissue is sent to the laboratory for examination and diagnosis (confirmation) of the abnormality.
Laser Treatment - heat from a laser beam is used to remove or destroy abnormal cervical cells under local anaesthetic.
Cyrosurgery - intense cold is used to destroy the area under local anaesthetic.
Diathermy - heat is used to destroy abnormal cervical cells under anaesthetic.
Cone biopsy - a larger cone shaped section of the cervix containing the abnormal cells is surgically removed under anaesthetic. Tissue is available for laboratory examination. A general anaesthetic may be recommended.
Hysterectomy (occasionally advised) - a total hysterectomy is a major operation to remove the uterus and cervix under general anaesthetic. Normally there is no need to have a hysterectomy solely because abnormal cervical cells are present. Some women choose this option for treatment after discussion with their specialist if they have finished having children and have other problems such as heavy bleeding for which a hysterectomy may be recommended.

Are there any risks to having treatment?

There is always a small risk with any surgical procedure. There are fewer risks associated with having a local than a general anaesthetic. Bleeding and infection are the commonest risks, though they are uncommon. The LLETZ procedure, unlike some of the procedures used in the past, does not appear to interfere with conceiving or with pregnancy. Four months after LLETZ surgery the cervix usually looks normal or nearly normal again.

What happens after a women has had treatment?

A colposcopy is carried out four to six months after treatment so that the gynaecologist can check that no abnormal areas are left. A cervical smear will be taken at the same time. The woman is then discharged back to her general practitioner or smear taker and should continue to have smears according to the guidelines.

Who has access to my information?

Only authorised personnel have access to your records. Information can only be released outside the Programme to your health practitioner(s), evaluators or a review committee to check how well the Programme is working.

How does a women enrol in the programme?

All cervical screening results are forwarded to the programme and all women are enrolled unless they write a letter to the programme or complete a 'Withdraw from the programme' form.

Does a women have to take part in the programme?

No. A women can decide at any time she does not want to take part in the programme and withdraw. When a woman withdraws, she and her smeartaker are responsible for her own screening. This means the programme will not:

make sure a complete record of your cervical screening history exists even if you change your doctor or smear taker
send reminder letters if you are overdue for a smear, or
make sure you get the right tests and treatment if you have an abnormal result.

What does withdrawing from the programme mean?

Withdrawing from the Programme is when you choose to have a smear but not to take part in the National Cervical Screening Programme. This can be either:

before you have been enrolled in the Programme (preventing enrolment)
when you change your mind at a later date and decide you no longer want to take part in the programme (cancelling enrolment).

What does withdrawing from the programme mean for me?

When you withdraw, you and your smear taker are responsible for your own screening. This means the Programme will not:

make sure a complete record of your cervical screening history exists even if you change your doctor or smear taker
send reminder letters if you are overdue for a smear, or
make sure you get the right tests and treatment if you have an abnormal result.

What happens to my information if I withdraw?

When you withdraw, the Programme is required to delete all of your electronic records except for background details to identify you as a woman who does not wish to take part. This reduces the risks of future results being accidentally added to the NCSP-Register. All of your paper records will also be destroyed unless you request these to be returned to you.

What are background details and why does the programme keep them?

When you withdraw, the Programme is required to keep your background details. These are your name, date of birth, NHI number (if known), address and ethnicity. This allows the Programme to correctly identify you as a woman who does not wish to take part in the Programme. This reduces the risks of future results being accidentally added to the NCSP-Register.

There is a very small chance this may still happen should you change your name in the future. This would mean you would be re-enrolled in the Programme at that time. If this happened and you still did not wish to be part of the Programme then you would then need to withdraw again.

The Programme keeps ethnicity details to help make decisions on how the Programme can be improved.

How do I withdraw from the programme?

You fill in a 'withdraw from the programme' form, which you can get by ringing the NCSP on freephone 0800 50 60 50. You can also download the form.

Download a 'withdraw from the programme' form

Can you guarantee all my records are destroyed?

There is a small chance some of you paper records from before March 2005 may be kept by the programme. Before March 2005, when the law was changed, the filing of paper records was done in date order and not by individual women. With this type of filing system we cannot always guarantee that we have found all of your paper records. If this is the case, the programme will not use them.

What happens if I change my mind and want to take part in the programme after I have withdrawn?

If you withdraw from the programme, you are welcome to re-enrol at any time by filling in a 're-enrol in the programme' form, which you can get by riging the NCSP on freephone 0800 50 60 50. You can also download a form. Your screening history will begin with your most recent smear.

Download a 're-enrol in the programme' form

What is an NHI number?

The National Health Index (NHI) number is a unique number that is assigned to each person using health and disability support services. The number allows you to be identified medically.