Earlier this year, at age twenty-five-and-three-quarters, I had my first smear test. I’d received my invitation letter nearly a year ago and had rolled my eyes before popping it at the bottom of my to-do list along with the likes of, ‘clear out freezer’ and, ‘ring EE to change contract’.
Part of me couldn’t be bothered, part of me assumed it would definitely come back clear (I’d had the HPV vaccine after all), and part of me just really didn’t fancy having a stranger shove a brush up my vagina.
But instead of the ‘come back in three years’ letter I’d been expecting, I got a ‘come to the hospital for a colposcopy’, which led to ‘your smear showed severe pre-cancerous cells covering the entire surface of your cervix’, and finally to ‘I’m afraid we found a small area of cervical cancer’.
I am incredibly lucky that it was detected early, and that my treatment has been far less aggressive than it could have been. That said, I can’t say that I have felt particularly lucky when it comes to my cervix. I didn’t feel lucky when I was shown a blown-up image of my cervix on a big screen to highlight the extensive abnormalities. I didn’t feel lucky as I lay with my legs up in stirrups whilst the doctor clamped me open and cut bits off my cervix. Or when he told me that if I was fifteen years older he would ‘just do a hysterectomy’. And I definitely didn’t feel lucky when I had severe post-treatment bleeding at work and spent half an hour mopping up my own blood with paper towels, before finally admitting defeat and asking our mortified facilities assistant if he could possibly fetch me a mop.
Cervical cancer is one of the most common cancers in women under 35. It is caused – in 99.7% of cases– by the HPV virus, a virus which almost everyone will contract, through sexual contact, at some point in their lives. Despite this, cervical screening has reached a 20-year low, with 1 in 4 of us skipping our smear tests. In 2009, Jade Goody’s tragic battle with cancer brought cervical screening to the forefront of the national media, boosting the number of women attending their smear tests by 12%. But, to quote Robert Music, CEO of Jo’s Cervical Cancer Trust: nine years on,“the Jade Goody effect has long gone”.
Whilst the Cancer Strategy for England emphasises prevention, the reality is that, though smear tests prevent 75% of cervical cancer, very little is being done to increase screening rates. A study last year found that 44% of local authorities and 60% of CCGs have done nothing in the past two years to try and increase screening attendance.
In schools, whilst the HPV vaccine is now given to all girls aged 12-13, little is done to ensure a real understanding of what the vaccine is for and what it does – and doesn’t – prevent. Putting condoms on bananas and memorising PMS symptoms will no doubt always have their place in sex education lessons, but it is time cervices were deemed equally as important. Schools and universities could – with support from primary care providers – play a crucial role in combatting the falling screening rates. For young women, many of whom skip their smear tests due to embarrassment, instilling confidence early on will be key to empowering earlier cohorts of women to see cervical screening as a priority. From ensuring women know that they’re allowed to ask for a smaller speculum, to teaching them that that minor cell abnormalities are pretty common and often don’t require treatment, to reminding them that the medical professionals who conduct smear tests will have seen so many vaginas in their lives that they really, really don’t care what yours looks like.
Whilst I don’t necessarily agree with those campaigning for the screening age to be lowered – and nor do I have the medical expertise to offer an informed opinion – educating young women about a screening programme that is certain to feature in their lives in the future is an undeniably worthwhile exercise.
This lack of awareness has left millions of women dangerously complacent when it comes to cervical screening – a complacency that rapidly transforms into absolute terror at the mere mention of the words ‘abnormal smear’. Online discussion forums on cervical cancer are a minefield of frightened women desperately trying to navigate their way through an entirely foreign situation. There’s an innate vulnerability that comes with having something go wrong in such an intimate area – and one which is all the more isolating when no one around you, yourself included, has a real understanding of what’s going on down there. From women who’ve been diagnosed with CIN 2 mistakenly believing they have Stage 2 cervical cancer (CIN is actually the staging system for pre-cancerous cells) to women frantically telling others to shove tampons dipped in cannabis oil up their vaginas and practice cervix meditation (no comment), to younger women wondering how they could possibly have cervical cancer if they’ve had the HPV vaccine (which, in fact, only prevents 70% of cervical cancer). That so many women are so ill-informed about our own bodies is not only deeply worrying, but incredibly dangerous.
We are now in need of a much louder national conversation on cervical screening. I had none of the symptoms: no bleeding between periods, no painful sex, no back pain. I was happily oblivious to the cancerous cells growing inside me, and – were it not for the smear test – could have ended up with a much more aggressive cancer. We desperately need a greater level of awareness about what the smear test actually is (not a test for cervical cancer, but a test for early cervical abnormalities), what exactly it consists of (a reassuring briefing from a lovely nurse, followed by 30 seconds of mild discomfort), and the very real consequences of choosing not to participate in the cervical screening programme. This is a job for us all: for GPs, for local authorities, for CCGs, for schools and universities – but also for all women and men.
None of us are invincible. But smear tests offer a rare comfort blanket within the inevitable fragility of life. A privilege offered to us by the NHS; the security that minor cervical abnormalities can, very often, be detected before a single cancerous cell even exists. To delay or neglect your smear test is – to be blunt – to take a gamble on your own health.
So, if you do one thing today, ask a woman you care about – be it your mum, your sister, your daughter, your colleague – whether she’s had her smear test recently. They’re less painful than stubbing your toe, quicker than popping into Pret for a latte, and less embarrassing than accidentally sending your boss a text with an inordinate amount of kisses. And they literally save lives.