Campaign has young women in its sights
Anew and seriously funky national campaign has launched, aimed at encouraging more women aged over 25 years to take part in the cervical screening programme.
The campaign uses a dancer to personify the cervix and a series of short video clips talk you through the process of getting a smear test, from start to finish. It’s warm, engaging and surprisingly quite cool. If you don’t believe me, check it out for yourself by visiting the website starttoscreen.nz.
However, there is a serious message behind this light-hearted campaign – data shows that fewer and fewer young women aged 25-30 are attending for their cervical smear, and the numbers are particularly low for Ma¯ ori and Pasifika wahine.
Anecdotally, we are also hearing that many people who identify as trans or non-binary (yet still have a cervix and should also be screened) aren’t attending, either.
The risks of not being screened are very real. Cervical smear tests aim to pick up pre-cancerous changes in the cells of the cervix (the channel or ‘‘neck’’ of the womb, that sits at the top of the vagina) long before they become cancerous.
It takes an average of 10 years for pre-cancerous changes to develop into full cervical cancer, so if these early changes are picked up during a routine cervical smear test, there is plenty of time to have treatment, and stop the cancer developing.
In theory therefore, if everyone had their screening on time, this type of cancer should be largely preventable. Despite this, we know that approximately 150 women still develop cervical cancer every year in Aotearoa, and around 55 of them will die as a result.
The reasons people don’t attend for screening are complex but I suspect for many there is still a stigma or fear around the process. Young women particularly will often tell me they feel a sense of shyness or whakama¯ about someone looking at their genital area, or that they are worried it will hurt.
I remember feeling this way myself, attending for my first smear decades ago. Most of us aren’t used to exposing that part of our body to someone we don’t know, and of course it makes us feel uneasy. Because of this, when I see someone for their smear, especially if it’s their first one, I spend most of the appointment talking them through the process, and only a few minutes doing the test.
I try to ensure everyone knows that I am experienced at taking smears, as are my colleagues – the average GP, nurse, family planning doctor or gynaecologist will do smear tests every week, if not several every day. It is a routine part of our job.
This means we have seen hundreds, if not thousands, of genitals, and we understand that they all come in different shapes, sizes and colours. There is no ‘‘normal’’ way for that part of our anatomy to look, so don’t worry that yours may look ‘‘different’’ to anyone else’s.
I also try to ensure my patients know why we take smear tests and what they tell us. When we do screening tests (such as smear tests) as opposed to diagnostic tests, we are looking for signs that tell us someone may have a problem.
If we do pick up a possible problem, we then need to confirm it with other testing (in the case of cervical screening, this is known as colposcopy). This is because screening tests are not perfect, and can miss some cancers, but they are the most viable method of testing entire populations.
It’s also important that patients know what the procedure involves.
Asmear test takes about three minutes. It involves removing your lower clothing and underwear, and lying (usually on your back, but it can be done on your side if this is more comfortable) on the examining couch in the doctor’s room.
You will be given a blanket or sheet to cover your lower abdomen, and can always have a support person or wha¯ nau member with you if you’d like.
The doctor will ask you to bend your knees and slightly separate your legs, and will then gently insert a piece of equipment known as a speculum. Although the speculum looks a bit scary, most of it stays outside your body and just assists the doctor to do the test properly.
The only bit that actually goes inside is about the width and shape of one or two fingers. Once the doctor can see your cervix through the top of the speculum, they will collect the test, using a small soft brush.
The speculum is then removed, and the test is
finished. Although it is a bit uncomfortable, it shouldn’t hurt – if it does, your doctor may suggest trying another position, or getting you to put your hands under your buttocks, which can alter the position of the cervix, making it easier to take a sample.
Occasionally there will be a tiny bit of spotting after a cervical smear, but it won’t cause any more bleeding than this.
What happens next? Smear results are usually available between one and two weeks from the time of the test. How you get the results will depend on your clinic’s process, so don’t forget to ask about this.
Personally, I text everyone if their smear is normal, and phone anyone who has an abnormal result so we can talk about next steps, but some clinics may send you a letter, or get you to access the result via their online portal.
Anyone with a normal smear will be recalled in either one or three years’ time for their next test, depending on their age and whether or not they have had abnormal tests in the past.
When you have a smear test, it’s a good opportunity to talk about your contraception and sexual health needs as well. It’s simple for your smear taker to screen for sexually transmitted infections at the same time if you would like one, and it’s a great time to book in for your Gardasil injection if you haven’t already been vaccinated.
This vaccine immunises against HPV (the virus that causes cervical cancer), so ensuring you are fully vaccinated as early as possible is the best way to reduce your risk of ever developing this type of cancer. Gardasil is free for males and females from 9-26 years of age.
Spending time having this conversation is a great way to reduce the uncertainty people feel about having their smear test. Hopefully it empowers people to start their screening journey and talk to others about it, too.
Encouraging our friends and wha¯ nau to enrol is something we can all do: it’s vital we look after our bodies, and getting involved in screening programmes, whether it be for our cervix, breasts, bowels or anything else, is an important part of that.
For more information on the new cervical screening campaign visit timetoscreen.nz, and for information on HPV, cervical cancer and Gardasil vaccines, visit HPV New Zealand on https://www.hpv.org.nz/