Unmasking the Hidden Threat: Smears and HPV Unveiled (by Dr Doireann O'Leary)

Hello and welcome!

I hope you guys found my newsletter this week really insightful. I discussed HPV and some facts and myths around the virus. If you have not yet read my newsletter, you can sign up here.

My blog today will further elaborate on the HPV virus and Cervical Screenings. I will also discuss Cervical Checks, why they're important, what the results can mean and the different symptoms to look out for, for cervical cancer. 

What is HPV?

HPV is probably something you’d rather not talk about it but it’s important to know about as over 90% of us will have it at some point. 

Human Papilloma Virus (HPV) is a family of very common viruses that are passed on during skin-to-skin contact, particularly sexual activity,including oral sex. There are over 100 types of HPV and most do not cause any problems. Certain types are considered high risk and increase the risk of cancer. It's a large family of viruses with over 100 strains. Some are more serious than others; HPV 2 and 10 are benign, causing warts you on your hand or foot for example. HPV 6 and 11 are more serious; they cause genital warts. These are relatively easy to treat.

What is Cervical Check?

Cervical Check is the organisation that oversees cervical cancer screening in Ireland. The program offers a free screening test to every person with a cervix in Ireland from age 25 to 65. Tests are typically every 3 years from age 25 to 30 and every 5 years from age 30 to 65.

You’re still advised to attend for screening even if you’ve had the HPV vaccine. The vaccine reduces risk of Cervical Cancer. It doesn’t eliminate it.

What happens at a screening test?

A screening test involves your GP or practice nurse using a vaginal speculum to examine your cervix and taking a sample to send to the lab. They’ll also talk to you about “red flag” symptoms to watch out for like unexplained bleeding between periods or bleeding after intercourse. 

It’s important to remember that this test is not a test for cancer; It’s a screening test designed to pick up early cell changes before they develop in to something more serious. It could be described as a pre cancer test.

The speculum examination usually takes a minute or so. The doctor or nurse examines your cervix with the naked eye to see if there are any large abnormalities of the cervix; then they take a brush to gather some cells to send to the lab for closer inspection under the microscope.

You can attend any surgery registered with Cervical Check. A full list of registered surgeries is available on the Cervical Check website.

Results

Results typically take about 4-6 weeks to come back from the lab. The way the samples are tested changed in 2020. In my newsletter I spoke about what happens with your sample from your smear test and I broke down the different strains of Cytology. The lab now checks all sample for HPV. 

If HPV is found, your same test sample will be checked to see if you have any abnormal (pre-cancerous) cells in your cervix. 

If HPV is not found, there is no need to check for abnormal cells. This is because your risk of developing cervical cancer is very low if you do not have HPV.

What if I have HPV + no cell changes?

You will be recalled in one year by Cervical Check. You will be tested again for HPV.

• If HPV is detected again at your one year check, you will be referred to a specialist gynaecologist at a Colposcopy Clinic.
• If HPV is not detected at your one year check-up, you’ll return to routine recall.

What if I have HPV + cell changes?

This will trigger immediate referral to a specialist gynaecologist at Colposcopy.

I sometimes get messages on social media from women who express concerns about this new HPV screening program that only checks for abnormal cells if HPV is detected. I let them know that this method of screening is actually superior to the previous screening program and Vicky Phelan actually campaigned for this method of screening to be implemented before her untimely passing. The old screening program detected about 15 cases of pre-cancer cases per 1000 women screened; the new program detects 18 cases per 1000.

What Is a Colposcopy Clinic?

This is a clinic where a gynaecologist examines the cervix in more detail. The experience for the patient is not dissimilar to a smear test at the GP surgery. The gynaecologist may take a biopsy if they think it’s necessary and or may treat any abnormalities detected.

 

Click on the image to read the Colposcopy leaflet

 

Is there a treatment for HPV?

If you have tested positive speak to your GP or gynaecologist about a new treatment called Papilocare. It’s a vaginal treatment, available over the counter, that has been shown in small, early studies to increase clearance rates of HPV. In future, we may see the HPV vaccine being used as treatment for HPV but this isn’t common practice yet. It’s important to quit smoking if you have HPV as smoking is another risk factor for cervical cancer. Smoking and HPV are not a good combination.

I speak further on the different types of HPV strains and treatment in my newsletter, so be sure you're signed up to read!

Almost all cervical cancers are caused by infection with high-risk types of HPV.

But most people who have HPV, even the types that cause changes to the cells of the cervix, do not develop cervical cancer.

So to roundup, keeping up to date with your smear test is incredibly important. This service is free and available to any woman if you are age 25 to 65. 

Please do not refrain from attending your appointment because life is busy or something else took priority. Your health is your priority. I know a lot of the above may seem daunting but let’s end on an uplifting note. Did you know that we can eradicate cervical cancer in our lifetime? This can be achieved through a combination of vaccination and screening. It can be done but we need your help. So book your screening test today by clicking here!

Thank you for reading my blog post,

Dr Doireann O'Leary 

 

 

*images sourced through Google, Canva & the HSE website.

further information sourced thorough HSE.ie