22 January 2024

My smear was normal but I’m still worried about symptoms – what should I do?

22 January 2024

It’s believed cervical screening, aka smear tests, prevent more than 70% of cervical cancer deaths – and this figure would be even higher if everyone eligible attended, according to Cancer Research UK.

Smear tests don’t diagnose cancer, but can reveal whether someone is at higher risk of developing it. These days, this is usually by detecting high-risk human papillomavirus (HPV), which is recognised as the most common cause of cervical cancer (however, it’s important to note HPV is extremely common, many strains are not linked with cancer, and the body often clears the virus itself with no problems).

If high-risk HPV is detected though, samples will then be checked for cell changes, and the results will determine whether someone is then referred for more thorough investigations, treatment, monitoring more closely, or simply invited back for their next routine screening in another three or five years.

But, what if you’re up to date with your smears and are still worried something could be wrong? Maybe you’ve noticed some abnormal bleeding, like spotting between periods or after sex, unusual vaginal discharge, or pain and swelling that’s bothering you. These are all symptoms linked with cervical cancer, but they can also occur for a wide range of other reasons too.

We put our most pressing smear test concerns to the experts…

My smear test came back normal, but I’m still worried about symptoms I’m having – is there any chance the results could be wrong?

“Cervical screening detects high-risk HPV and is the best way to find out who is at higher risk of developing cervical cell changes or cancer. However, like all screening tests, HPV primary screening isn’t always accurate. There is a small chance your result could be wrong,” says Bridget Little, head of support services at Jo’s Cervical Cancer Trust.

“If you have symptoms, you should always discuss these with your GP as soon as possible – don’t wait until your next cervical screening appointment.”

Consultant gynaecologist Dr Jo Bailey says: “The cervical screening programme is very good and has saved many lives, but it is not perfect. Even if you have had a normal smear and have bleeding after sex, pain during sex, or a discharge that smells, you should see your doctor for further investigation. For the majority of women, there will be a cause that is not cancer, but it is always worth getting it checked.”

What about people who get cervical cancer without having HPV – how would that get detected?

“Research suggests high-risk HPV causes nearly all cervical cancer. However, a very small percentage of cases don’t show high-risk HPV, and so would not be detected at cervical screening,” says Little. “This is why it’s important to be aware of any symptoms and changes, and to contact your GP if you notice anything that is unusual for you.”

I had a negative cervical screening a year ago, however I’ve since developed painful bloating and spotting after sex. My GP says there’s no need for another smear so soon, but can I push for one?

Little says: “Cervical screening is a test to prevent cervical cancer, not a test for diagnosing it. It’s also not possible to have a smear test on the NHS before you’re invited to have your next one. Symptoms such as painful bloating and spotting after sex can be indicative of a number of different conditions. Therefore, you should talk with your GP and they may refer you for other tests or examinations to determine what the cause is.”

Dr Bailey also emphasises the importance of seeing your GP for any new, ongoing or worsening symptoms: “There are a number of conditions that can cause these symptoms. In the majority of women, there will be a simple cause that is not related to cancer, which can be easily treated. However, in a small number of women there may be something more serious causing the symptoms and this should be investigated,” she explains.

“The warning signs for any gynaecological cancer include symptoms like bleeding or pain with sex, and a discharge that smells.”

For more information, visit Jo’s Cervical Cancer Trust or call their helpline on 0808 802 8000.

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