A smear test can save your life
New Zealand has a wellestablished cervical screening programme, available to all women from 20 to 70 years of age. We know without doubt that this type of screening saves lives – yet we still lose 60 women every year to cervical cancer. We also know that women in our Ma¯ ori, Pasifika and Asian populations attend far less often for smear tests, and are more likely to develop cancer as a result.
So if you are unsure about booking your smear test, or know someone who has never been for one but really should, here’s what it entails, and why it’s so important:
Cervical cancer is caused by exposure to HPV (human papilloma virus) through sexual contact. Most of us who have ever been sexually active will have been exposed to this virus at some point in our lives – but very few of us will ever know about it at the time.
There are many strains of this virus – some cause genital warts, but some lead to cancer of the cervix, throat, anus and penis. It is not possible to develop cervical cancer without exposure to HPV.
The relatively new, safe and incredibly important Gardasil vaccine protects against nine strains of HPV, including those most likely to cause cervical cancer. The earlier you are vaccinated (ideally before you start having sex) the more protection you will get, and the lower your risk of developing cervical cancer later on. Gardasil is now free for boys, girls, men and women, up to 26 years of age, and people outside of this age range can choose to pay for it if they would like to be vaccinated.
The cervical screening programme aims to pick up changes in the cervix long before they develop into cancer. In these early stages (known as CIN 1, 2 and 3) these types of ‘‘pre-cancer’’ are easy to treat – if left undetected, they may develop into full cervical cancer. Not easy to treat.
In all countries around the world which have established cervical screening programmes, the women who die from cervical cancer are the ones who have either never been screened, or have only been screened infrequently.
Our screening programme here recommends three-yearly check ups for everyone from 20-70 years of age. However, from next year the start age will go to 25 as we know that women younger than this are at much lower risk of cancer, and are more likely to have protection from the Gardasil vaccine.
All people who have ever had sex and were born with female genitalia (so this includes trans males) should get regular smear tests, even if they fall into the following groups:
❚ Single women
❚ Women in same sex relationships
❚ Women who are no longer having sex
❚ Women who have had the full course of Gardasil vaccinations
❚ Women who have been through the menopause.
It’s really important you feel comfortable with where you are going for your cervical smear, and who is going to be doing the test. All GP clinics offer this, and in many of them you can choose to have either your doctor or the practice nurse take your smear.
If you would rather go somewhere else that’s fine too. Family Planning, sexual health clinics, marae-based or other Ma¯ ori health centres, and community health services such as Pacific or women’s centres, all offer cervical screening. You can find out where to go, and ask about a female smear-taker if that feels easier for you, by calling the screening programmes free number 0800 729 729.
If you’ve never been for a smear before, I’d recommend you either talk to a friend or whanau member who has, or read the information on the website timetoscreen.nz – it talks you through what is involved, and what you should expect.
Having been for regular screening myself, but also having done thousands of smear tests over the years, I can assure you – if done well, with plenty of explanation and reassurance, it shouldn’t be a painful ordeal. It is super quick, as the test itself only takes about two minutes, and you can have whoever you like with you to support you if needed.
Many women I know find it very difficult to share this part of their bodies with a health professional, but as a doctor this is such a large, and important part of the work I do, I try to ensure that everyone feels OK about it – my philosophy is that if the first smear is done carefully, painlessly and thoughtfully, coming for the second one is a much easier process! So go on – pick up the phone and book yours!
❚ Dr Cathy Stephenson is a GP and forensic medical examiner.