Answers to some commonly asked questions about the National Cervical Screening Programme.
Cervical screening aims to detect abnormal changes to the cervix (the neck of the uterus or womb) before they can develop into cancer. Safe and effective treatment for pre-cancerous lesions detected by screening will prevent progression to cancer. When you have your smear you will be asked to lie on your side or your back with your knees bent up. The lower part of your body will be covered with a sheet. The smear taker gently opens the vagina with a plastic or metal speculum and carefully sweeps a sample of cells from the surface of the cervix with a thin broom or brush. It takes only a few minutes to take the smear. Some women may find the test a little uncomfortable. The test sample is either smeared onto a glass slide or placed in a liquid. It is then sent to a laboratory approved by the NCSP.
All women who have ever been sexually active should have regular cervical smear tests from the time they turn 20 until they turn 70. This includes:
All women are advised to start having regular cervical smear tests at the age of 20. Screening at a younger age is not recommended, even if a woman has had sex. Screening from 20 onward is recommended because, in New Zealand, it is very rare for women under this age to develop cervical cancer.
Some older women think they do not need to have cervical smear tests, especially if they are no longer sexually active. However, there is still a chance that abnormal cells will appear in later life and progress to cancer. If older women continue to have regular cervical smear tests until they turn 70, it is likely that any abnormal cells will be found and treated before they become cancer.
It is very unlikely that women over 70 will develop cervical cancer if their previous smears have been normal. However, women aged 70 and over who have never had a cervical smear test are advised to have a smear test followed by another a year later. If both tests are normal, no further tests will be needed.
If a woman has had abnormal smears in the past, her smear taker or doctor will advise her when it is best to stop having cervical smear tests.
The NCSP recommends that women have a cervical smear test every three years from the time they turn 20 until they turn 70.
Three-yearly testing has been chosen because it gives very good protection against developing cervical cancer while keeping to a minimum the number of smears a woman needs in her lifetime.
There are certain clinical situations in which a woman may be advised to have cervical smear tests more often than every three years.
It is important that you feel comfortable with the person who takes your smear. You have a choice of where to go to have smears:
Women who have had a subtotal hysterectomy (in which the cervix is not removed) need to continue to have cervical smear tests.
Women who have had a total hysterectomy (in which both the uterus and the cervix are removed) do not usually need to have smear tests unless advised to do so. Reasons they need to continue to have smear tests might include:
When a woman has had a total hysterectomy, the smear (called a vaginal vault smear) is taken from the top of the vagina. If you are not sure whether you need to continue to have cervical smear tests after a hysterectomy, ask your doctor.
In some situations, women having a cervical smear test will also be offered an HPV test. This test is an accurate way to tell if one of the high-risk HPV types is present in a woman’s cervix. The test is usually taken at the same time as the smear test and can use the same sample of cells. A positive test result means that a woman has high-risk HPV. She should be monitored to see that the infection goes away and that she does not develop abnormal cells.
A positive HPV test does not mean that a woman has cancer.
A person can have HPV for a long time before it is found.
Screening for high-risk HPV is usually carried out as recommended by the Cervical Screening Guidelines, which can be found in here: Guidelines for Cervical Screening in New Zealand
Women under 30 are not recommended to have an HPV screening test in addition to the cervical smear test, because HPV infection is very common in this age group and usually goes away on its own.
Cancer is a general term used to describe cells that grow in an uncontrolled way. There are many 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.
Cervical cancer is caused by certain types of HPV. Of the nearly 200 types of HPV, about 40 infect the genital area, and about 15–20 of these high-risk types can cause abnormal cells, which may progress to cancer. The 15 high-risk oncogenic (cancer-causing) types of HPV are: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68 and 73.
Genital HPV is spread by skin-to-skin contact during sexual intercourse with a person who has the virus. Genital HPV is the most common sexually transmitted infection, affecting an estimated 80 percent of sexually active women at some point in their life and probably as many men.
Most women who get HPV (especially those under 30 years) will clear it in 6–24 months without even knowing they had it. However, some will not clear their HPV and will develop a persistent infection. Women who have a persistent infection with a high-risk type of HPV may go on to develop cervical cancer if not treated.
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.
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.
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.
Research shows that lesbians do develop cervical abnormalities and so need to have regular smears.
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.
Women who are pregnant or have a new baby and are due for a cervical smear test should check with their midwife, specialist or lead maternity carer (LMC) before having a smear.
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.
You will be asked to lie on your side or your back with your knees bent up.
The lower part of your body will be covered with a sheet. The smear taker gently opens the vagina with a plastic or metal speculum and carefully sweeps a sample of cells from the surface of the cervix with a thin broom or brush. It takes only a few minutes to take the smear. Some women may find the test a little uncomfortable.
The test sample is either smeared onto a glass slide or placed in a liquid. It is then sent to a laboratory approved by the NCSP.
If you or someone in your family needs an interpreter or has another special need, talk to the person making your appointment about how this need can be met.
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. The programme will also write to you if, in future, you have any abnormal results.
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.
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.
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.
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.
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.
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.
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.
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.
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 changes means that cells have moderate or more serious abnormalities. 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.
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.
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:
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.
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.
There is a small chance that some abnormal cells will be missed during sampling or slide reading (called a false negative). Abnormal changes to cervical cells progress very slowly. It is likely that any abnormal cells missed at one regular check will be picked up at the next.
There is also a small chance that a result will say that abnormal cells have been found when the cervix is quite normal (a false positive). If the result from further testing shows that there are no abnormal cells, no treatment will be needed.
A cervical smear has a false negative rate of about 20 percent for high-grade lesions. The test is not reliable in the presence of clinical symptoms.
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.
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).
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.
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.
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.
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:
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.
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.
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.
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.
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:
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:
When you withdraw, you and your smear taker are responsible for your own screening. This means the Programme will not:
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.
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.
You fill in a 'withdraw from the programme' form.
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.
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 ringing the NCSP on freephone 0800 50 60 50. Your screening history will begin with your most recent smear.
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.
0800 729 729