Cervical screening – when to go, and what happens

Cervical cancer is caused by persistent infection with certain types of human papillomavirus, or HPV — a very common virus that most people encounter at some point and clear without ever knowing.

It is one of the few cancers that can be caught at the stage before it is cancer. Screening finds abnormal cells that could become cancer over years, and treating them at that point prevents the cancer entirely. It is also more common in South Africa than in most countries, and considerably more so in women living with HIV.

This differs from country to country, so foreign advice will not match what a South African clinic offers.

• In the public sector, screening is offered from age 30, with smears at ten-year intervals.
• Women living with HIV are screened differently: from the time of HIV diagnosis regardless of age, and more frequently thereafter — your HIV clinic will set the interval.
• In the private sector, screening usually starts earlier and is repeated more often, commonly every one to three years depending on the test used and previous results.
• If a previous smear was abnormal, your interval is set by that result, not by the general schedule.

The fear of the procedure keeps a lot of women away, and it is usually worse in the imagination than in the room. The whole thing takes a few minutes.

1. 1You undress from the waist down and lie on the bed with a sheet over you.
2. 2A speculum is gently inserted so the nurse or doctor can see the cervix. This is the uncomfortable part — pressure rather than pain for most women.
3. 3A small brush is used to collect cells from the surface of the cervix. It takes seconds.
4. 4The speculum is removed and you get dressed. Some light spotting afterwards is normal.
5. 5Results usually take a few weeks. Ask how you will be told, and follow up if you hear nothing.

• Try to book when you are not bleeding — mid-cycle is ideal.
• Say if you have never had a smear or find it painful; a smaller speculum and more time make a real difference.
• You can ask for a female clinician, and you can ask them to stop at any point.

An abnormal smear is common and very rarely means cancer. It usually means cells that look changed and need watching or a closer look.

The usual next step is a colposcopy — the same position and speculum, but the clinician uses a magnifying instrument to look closely and may take a small sample. If treatment is needed, the abnormal area is removed in a short outpatient procedure, and that is generally the end of it.