Up-to-date with a cervical screening test?

Dr Jung-Yoon Huh

As a GP, the most rewarding aspect of my work is an opportunity to promote and practice preventive medicine in the community. I witnessed first-hand the devastating effects of cervical cancer in a patient during my hospital training days. This left a big impact on me and not a day goes by without me asking patients about their last cervical screening test (CST). In this article, I’d like to share some of the questions I frequently get asked during a consultation.

1. Why do I need to have a cervical screening test?
CST is a screening test for cervical cancer as mammogram is for breast cancer. Early cervical cancer rarely causes symptoms. However, some patients may experience vaginal bleeding between periods, abnormal menstrual bleeding, bleeding after intercourse, painful intercourse, unusual vaginal discharges, fatigue, leg pain or swelling or lower back pain. As you can tell, some of these symptoms can be caused by other less serious health conditions. This emphasises the importance of a regular screening test to detect early changes.

2. Is CST for everyone?
No. CST is for women aged between 25 and 74 years old who have been or currently sexually active.

3. Is this painful?
The procedure involves a patient lying on her back with legs apart. Then a speculum is gently inserted into the vagina. This may cause discomfort but rarely painful. We have highly trained GPs and a women’s health nurse at the Madison Medical Practice, who perform this test on a daily basis.

4. When is the best time to have the test done?
You can come at any time in your menstrual cycle, except for during period.

5. How is this different from Pap test?
The current CST was introduced in December 2017. It replaces the previous screening test for cervical cancer, called Pap test. The reason for this change was due to the finding of high risk human papillomavirus (HPV) being responsible for over 99.7% of cervical cancer cases. It is the persistent infection of high risk HPV that causes cancer, often without symptoms. Since the changes occur over several years, the recommended period for CST is every 5 years, not 2!

6. I tested positive for HPV. What does this mean?
Think of HPV as the ‘common cold’ in sexually active people, transmitted by genital skin-to-skin contact. It affects up to 79% of sexually active women. There are about 40 genital HPV types, of 14 classified as oncogenic (cancer-causing). This is what gets tested in CST. In most cases, the immune system is effective in clearing the virus in 1-2 years without any treatment. However, if high risk strains are detected, your GP will refer you to a gynaecologist for more investigations.

7. I have unusual vaginal bleeding. Do I still need a CST?
Since the aim of a screening test is to detect early changes in healthy patients, if you have any symptoms you should consult your GP regardless of when your last screening test was. Your GP will perform a speculum examination, which is the same for CST, but order a different test alongside other necessary investigations. This will check if you have HPV and any associated abnormal cell changes in the cervix.

8. I heard about self-collection. Can I do this instead?
Ideally, a clinician-collected sample is preferred as cervix can be visualised during the procedure. However, if patient is over 30 years old, declines to be examined and overdue for more than 2 years or never had a screening test, she is eligible for self-collection. Ask your GP for more information if you are interested.

9. But I was vaccinated against cervical cancer. Do I still need to have the test?
Yes. Even thought the vaccine is highly effective in preventing a persistent HPV infection, it is not 100% effective. It is worth noting that the current vaccine provided by the school based program covers for 9 strains only. Not only that you can speak to your GP about other women’s health issues such as contraception, sexually transmitted infections, menopause to name a few.
If you’re ready to have a test or have any questions, feel free to make an appointment to see our highly trained doctors at the Madison Medical Practice.

For more information please watch this short film