Cervical screening (smear test)

Information about cervical screening (smear tests) in Scotland.

Cervical screening is a quick test to check your cervix for the Human Papilloma Virus (HPV).

What is HPV?

HPV is a common virus that can cause many different types of cancer. HPV causes 99% of all cervical cancers.

Cervical screening looks for the presence of the HPV virus in your cervix. 

Having both the HPV vaccination and cervical screening will dramatically reduce the number of people with cervical cancer in Scotland.

Cervical screening is routinely offered to anyone who:

  • women and anyone with a cervix
  • lives in Scotland
  • is between the ages of 25 and 64 years

You should be offered routine cervical screening every 5 years.

What's the cervix?

Diagram of the female reproductive system, with labels for the fallopian tubes, ovaries, uterus (womb), cervix and vagina. The cervix is the narrow part of the uterus (womb). It forms the connection between the uterus and the vagina. 

People who have a cervix include women, trans men, and people assigned female at birth (AFAB). 

Some women may not have a cervix, like those who've had a total hysterectomy. 

Non-urgent advice: Speak to your GP if you experience:

  • unusual discharge
  • bleeding after sex, between periods or after the menopause

These are usually caused by something other than cancer but it’s important to have them checked.

Signs and symptoms of cervical cancer

What is HPV testing in cervical screening?

There have been recent changes to the cervical screening programme in Scotland.

Previously, the samples collected during cervical screening were tested to look for changes to the cells that could indicate cancer.

Now, the samples collected during cervical screening are tested for the HPV virus.

This means healthcare professionals are able to identify those who are at risk of developing cervical cancer and monitor them. 

HPV testing is more accurate and reliable than the previous cell testing method. 

How often should I be screened?

The frequency of cervical screening tests in Scotland has recently changed.

You'll be invited for routine screening every 5 years if you:

  • have a cervix
  • are between 25 and 64 years of age

If your previous screening tests have found HPV, you may be invited for screening more regularly. This is so healthcare professionals can check to see if:

  • your body has managed to get rid of the virus
  • the cells of your cervix have started to show signs of cancer.

In most cases, HPV found during cervical screening won't develop into cervical cancer. Regular screening, however, means that if you do develop cancer it will be treated early.

Do I need to be screened

If you've had the HPV vaccine

The HPV vaccine protects against a lot of the different types of HPV virus that cause cancer. But it doesn't protect against them all.

It's important that you still go for regular cervical screening, even if you've had the HPV vaccine.

If you're pregnant or have just had a baby

You might not need cervical screening if you:

  • are pregnant
  • have given birth in the last 12 weeks

If you get an invitation and aren't sure that you need cervical screening, speak to your GP practice.

If you've never been sexually active

You might not need cervical screening if you:

  • have never been sexually active (as there's less risk of you having HPV)

If you get an invitation and aren't sure that you need cervical screening, speak to your GP practice.

If you've had a hysterectomy

If you’ve had a total or radical hysterectomy, your womb and cervix will have been completely removed. Your consultant gynaecologist will make sure you have a follow up, if needed. You’ll be removed from the cervical screening programme and you’ll no longer receive invitations.

If you’ve had a subtotal hysterectomy, only your womb will have been removed. This means you should still be invited for cervical screening as part of the Scottish cervical screening programme.

Cervical screening exclusion error

NHS Scotland has identified a number of people who may have been incorrectly excluded from cervical screening following a hysterectomy. Anyone affected by this error will be contacted by the NHS.

More about the cervical screening incident

Your screening invitation

When you get your invitation, read the information carefully and decide whether you want to take the test.

It’s normal to feel anxious, especially at your first appointment. Don’t let it put you off. Talk to your GP or nurse as they can help with any concerns, embarrassment or past experiences.

Appointments

Most people have the cervical screening test at their GP practice. If you decide to accept the invitation, contact your GP practice to arrange an appointment.

Try to make an appointment for a day when you won't have your period. During your period it's difficult to get a clear view of your cervix.

You can ask for extra support for your appointment. For example, you can ask for a translator, female nurse or GP. You can also book a longer appointment if you'd like a bit more time to talk things through.

Benefits of cervical screening

There are usually no symptoms with HPV or changes in cervical cells, and sometimes no symptoms with early stage cervical cancer.

Screening can find changes even if you feel healthy and have no symptoms. A smear test can help to find changes so that they can be monitored or treated.

Finding these changes at an early rather than late stage means:

  • they're easier to treat
  • you're 9 times more likely to survive cervical cancer

Cervical screening is the best way of finding out if you are at risk of cervical cancer.

Risks of cervical screening

There are some risks to cervical screening:

  • changes can happen between screening tests
  • no screening test is 100% effective.

It’s important to go for a smear test every time you’re invited and contact your GP practice as soon as possible if you:

  • have unusual discharge
  • bleed after sex
  • bleed after the menopause
  • bleed between periods

These are usually caused by something other than cancer but it's important to have them checked.

More about the symptoms of cervical cancer

Cervical screening after experiencing sexual violence

The thought of cervical screening can feel traumatic or distressing if you've experienced sexual violence. There are ways that the NHS can support you. For example, you can request a double appointment, take someone you trust to the appointment, or access a specialist clinic. 

Jo's Trust has further information and support for those invited for cervical screening after sexual violence

Taking the test

The cervical screening test takes a sample from your cervix. This sample is then examined for the presence of the HPV vaccine.

You'll have the test at your GP practice. The test usually takes no more than 5 minutes.

Before the test

At your GP practice, a health professional will check your details and explain the test to you. You'll have an opportunity to ask questions.

If you’d like them to send your results to another address, please tell the person doing the test.

Your cervical screening appointment will last about 10-15 minutes from start to finish.

The test itself should take no longer than 5 minutes.

Taking the test

Before the test starts, you'll be asked to undress from the waist down (or just to remove your underwear if you're wearing a skirt). You'll also be given a sheet to cover yourself.

You'll be asked to lie on an examination bed. The medical professional will gently insert a speculum (medical instrument) into your vagina to hold it open so they can see your cervix.

They'll then gently brush cells from your cervix using a soft brush.

Everyone is different. Some may feel discomfort and others can find the test painful. Tell your medical professional if you experience pain as they can discuss some options to help.

You can ask for a smaller speculum if you feel any discomfort or the medical professional might suggest you change your position slightly.

Your test samples

Your cervical screening test sample is sent to a laboratory where it will be tested for HPV.

If HPV is found, the same sample will then be examined for cell changes.

Your sample will be kept for at least 10 years to compare tests at different times. You'll be contacted if the results suggest your care should be changed in any way.

Your sample may be tested again so the NHS can evaluate how well it's preventing cancer.

Your test results

There are currently delays in issuing cervical screening results from both of the laboratories in Scotland.

Please do not worry if you have not received your cervical screening result within the standard 2 week period.

If you've been waiting more than 8 weeks for your result please ask your GP practice to contact the lab to check on your sample.

We found no HPV

Your risk of developing cervical cancer at this time is very low. We'll invite you for another routine screening test in 5 years.

We found HPV but no cell changes were seen

We'll ask you to come for another cervical screening test earlier than usual. This will be around 12 months after your result to check the HPV has cleared.

We found HPV and cell changes were seen

We'll ask you to come for further tests at a specialist clinic so we can take a closer look at your cervix. We'll let you know when you'll be invited for this.

Colposcopy

A colposcopy is an examination of the cervix using a special microscope called a colposcope. The colposcope magnifies your cervix so that the specialist can see where the changes are and what they look like.

More about how a colposcopy is performed

Treatment

Sometimes treatment isn’t necessary. If this is the case the specialist will explain why and will arrange for you to have smear tests more often.

In some cases you’ll be asked to come back to the clinic for further colposcopy examinations. Your follow-up appointment will be with your specialist, nurse or GP.

Unclear result

Sometimes for technical reasons the lab can't get a result. We'll ask you to come back for another cervical screening test. This is nothing to worry about.

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