A few years ago, I went for my routine smear test and didn’t really think much of it. Yes, it can be a little awkward and uncomfortable, but it’s not painful and is over within a couple of minutes. I went home and carried on with my day and the weeks that followed. However, the results letter came as quite a shock! I needed to book another appointment where they would do a biopsy as they had found some abnormal cells.
Fast forward to now and everything is fine, I’m happy and healthy, but this scare has always been on my mind as cervical cancer isn’t something I really know much about. As this week is cervical cancer awareness week, I thought I would do some research about what causes this cancer and how women like myself can try to reduce our risk.
So, what is cervical cancer?
This type of cancer develops in a woman’s cervix and mainly affects sexually active women between the ages of 25- 45. The cervix is a strong muscle and is the lower part of the womb (or uterus), part of your reproductive system along with the vagina and ovaries.
On the outside surface of the cervix, there are skin-like cells called the ectocervix. On the inside of the cervix, there are glandular cells that produce mucus and this is called the endocervix. Both of these cell types can become cancerous if left unchecked.
The area around the opening of the cervix is also known as the ‘transformation zone’, and this is the area where cells are the most likely to change and become cancerous. This is the area that your GP will check during your routine cervical screening (or smear test).
In the UK, around 3,200 women are diagnosed with cervical cancer every year, or about 8 cases per day which is quite staggering. Cervical cancer is more common in younger women, but trans men can also develop this if they haven’t had a total hysterectomy.
What are the symptoms of cervical cancer?
Not everyone will have symptoms which places even more importance on regular cervical screening. However, some of the most common symptoms can include unusual bleeding, pain or discomfort during sex, vaginal discharge and pain in the pelvis.
Unusual vaginal bleeding:
This is usually the first noticeable symptom, including bleeding between periods, bleeding during or after sex or bleeding after the menopause. This isn’t necessarily a sign that you definitely have cervical cancer as it can be caused by several other conditions, for example our hormone levels fluctuating, and sex can make bleeding more common. However, it is advised to still get this checked by your GP.
Pain during sex:
This is also known as dyspareunia. The pain can be intense and sharp and can occur during or after sexual intercourse. Again, there are other medical conditions that can cause this, but seeing your GP straight away is advised.
This is normal in most cases for women and usually nothing to worry about, but if the discharge changes in smell, texture or colour it could be a sign of an infection and worth seeing your GP.
Pain in the pelvis:
This can be caused from the cancer spreading out of your cervix into surrounding organs and tissues.
So, what actually causes cervical cancer?
The main cause is the human papillomavirus (or HPV). HPV is a very common group of viruses that in most cases, your immune system will clear without any problems. Most people will come into contact with HPV during their lifetime. There are 15 HPV types that are now considered high risk for cervical cancer. Two out of these 15 types cause around 70% of all cervical cancer cases. HPV is spread during sexual activity and intercourse, and the higher risk HPV types will stop the cells working normally, causing them to reproduce in an uncontrollable way and that’s when tumours can begin to grow.
Are there any other risk factors?
The more cigarettes you smoke and the younger your age when you start smoking, the higher your risk of cervical cancer. Treating abnormal cervix cells is made harder by smoking, and people who smoke are less able to naturally get rid of the HPV infection.
All girls aged 12-13 in the UK are now offered the HPV vaccine in school. This is done with 2 doses over 6 months. It’s also available on the NHS to all girls up to 18 years old, however anyone over 15 years old will need 3 doses. The vaccine will help protect against the most common HPV types, but it won’t protect against every HPV type. Cervical screening is still advised even after having the vaccine.
Cervical cancer has higher rates within women under 45 years old; more than half of all cases each year in the UK are women under 45.
Practising safe sex:
This will not only protect you from sexually transmitted diseases but using methods such as wearing a condom will also reduce your risk of getting HPV and then passing it on.
Women who have had children have a higher risk of cervical cancer compared to women who haven’t had children. Scientists are unsure why, but having a child before age 17 puts you at increased risk compared to someone who had their first child after 25 years old.
Sexually transmitted infections:
You are at higher risk of developing cervical cancer if you also have a sexually transmitted infection at the same time as having HPV.
Taking the pill for more than 5 years increases your risk of cervical cancer. 1 in 10 cases is now linked to taking the pill. However, the risk drops as soon as you stop taking the pill.
You are at higher risk if a first-degree relative (mother, sister or daughter) has had cervical cancer.
Previous other cancers:
If you have had urinary tract, kidney, vagina or vulva cancer, this will put you more at risk of cervical cancer potentially due to the radiotherapy treatment received.
What does cervical cancer screening look like?
The NHS screening programme for cervical cancer invites women between the ages of 25- 64, as well as others within that age range who have a cervix such as trans men. This screening process is done through your GP every 3 years from those between 25-49 years old, and then every 5 years until the age of 64.
Primary screening for HPV will test the cervical cells for the HPV virus, and a lab will look to see if you have any of the higher risk HPV types. The test is very quick and painless.
If the lab detects any cell changes or abnormalities within the cervix, you will be invited for a colposcopy done by a qualified nurse. As well as examining your cervix similar to the first screening test, they might remove a tissue sample to be checked for any cancerous cells. This is also known as a biopsy and you might have some bleeding and period-like stomach pains afterwards. If the results from the colposcopy suggest you may have cervical cancer or it is spreading, you will need further examination to assess how widespread it is.
What are cervical cancer survival rates like currently?
This is very hard to say as it will depend on the type and stage of the cancer, your fitness level and whether you’ve had any previous treatment. This is why attending regular screening and early detection is so vital.
Knowing that cervical cancer is largely preventable by doing just a few small things and living a healthy lifestyle, it really saddens us to think that women still don’t go to their routine smear test! You can usually request a female nurse if that makes you feel more comfortable too. So next time that letter comes through from your GP to attend your smear test, please go just in case something isn’t right and you will feel like a weight has been lifted once you’ve gone!