Voices: A gut feeling told me to have a smear test – I’m so glad I did
It’s almost impossible to describe a gut feeling. Yet we’ve all felt it, that gnawing, unshakeable sense of unease that lingers like an invisible chill inside your bones until you concede and do something about it.
My latest brush with this inexplicable internal alarm system started on an otherwise uneventful day in July, when I felt a sudden, overwhelming need to have a smear test. It was illogical, because I had received a clean bill of health at a full cervical and fertility check less than two years earlier. The specialist, in fact, had remarked that I had a “model uterus” and confirmed that there were no sinister cells inside my cervix.
It was hard to justify, because I hadn’t experienced any of the symptoms, such as pelvic pain or bleeding after sex, that are typically associated with cervical cancer. But there I was, driven by that niggling feeling, phoning my GP to make an appointment for the very next day. I will forever be grateful that I did.
Four weeks later, the sight of my doctor’s number lighting up my phone confirmed what my gut had already told me. The smear test had detected a positive HPV infection and abnormal cells, a combination that can, if left untreated, develop into cervical cancer. I hung up the phone, sobbing and shaken that something inside me had told me that all was not right with my body.
Six weeks later, I sat with my legs in stirrups in the women’s ward of an east London hospital as a doctor swept cobalt-coloured dye inside me and scanned my cervix for signs of cancer. Biopsies taken during the colposcopy – the name for the procedure that closely examines your cervix, vagina and vulva for signs of disease after an abnormal smear test – confirmed that I had low-grade dyskaryosis, medically known as CIN 1. These changes are not cancer, and in most cases do not lead to cancer in the future, but they do require monitoring with a further smear test in 12 months to determine whether the cells have returned to normal. I was lucky enough not to require further treatment.
My smear test results came in the midst of the most stressful year of my life. I had just moved from Australia to the UK to start a new job when my dad was diagnosed with terminal cancer. I was flying home every other week to be with him, and breaking down in tears at least once a day from grief and exhaustion. I was drinking too much, not eating enough, not sleeping enough, a vape clutched in my hand at all times in a misguided attempt to ease the stress.
My abnormal smear result was the wake-up call I needed to change my lifestyle, but I worry that thousands of women are missing the opportunity to put their health first.
Last month, NHS data showed that smear test rates have plunged to a record low in the wake of the pandemic. Just 69.9 per cent of eligible women between the ages of 25 and 64 took up the offer of free cervical screening last year, meaning that uptake is now at its lowest for a decade.
After the death of reality TV star Jade Goody from cervical cancer in 2009 at the age of just 27, smear test attendance reached a new high. But once again, women aren’t coming forward, and in failing to do so are putting their lives at risk. About 3,200 new cervical cancer cases are diagnosed every year in the UK, most frequently in women in their thirties, and there are about 850 deaths from the disease each year.
Smear tests are free and take less than five minutes to complete. They are practically painless, and I have never had one completed by a doctor who wasn’t the pinnacle of compassion, respect, and kindness. Cervical screening has also evolved in incredible ways over the past five years.
Up to December 2019, smear tests were performed using a cytology test. This involved taking a sample of cells from the cervix, which were then examined for abnormal changes. Depending on the severity of the changes (many resolve naturally, like my low-grade CIN 1 hopefully will), women were referred for further investigations and, in some cases, the removal of pre-cancerous lesions.
But scientific advances mean that now, the smear test also looks for the presence of the human papillomavirus (HPV), a virus that is the cause of virtually all forms of cervical cancer. Roughly 80 per cent of sexually active men and women will be infected with HPV in their lifetime. In most cases it is harmless, and the immune system clears the infection without any trouble.
But in some cases, often when the body is weak and under stress, HPV can burrow into tissue, leading to cell changes that trigger cervical and other cancers, including of the head, neck and mouth.
Under the new system, if HPV is present in the initial test, the same sample then undergoes another check that looks for abnormal cells. The results of that second test determine whether the woman will receive more frequent screenings, or if further tests should be carried out.
This process offers a double layer of protection that we are incredibly fortunate to have, so it pains me that just seven in 10 women who are eligible for this life-saving service are turning up to use it.
In the UK, the NHS cervical screening programme invites women aged 25 to 49 for a smear test every three years; those aged 50 to 64 every five years; and women over 65 if they have not been screened since the age of 50, or have previously had abnormal results.
If you are overdue a smear test, or putting it off because you haven’t experienced typical cervical cancer symptoms – which include bleeding after sex, bleeding between periods, pelvic pain, pain during sex, or vaginal discharge that is foul-smelling or contains blood – take two minutes out of your day to book an appointment now. Let me be your gut feeling – I’m so glad I listened to mine.
