Changes to the way we screen for cervical cancer are expected to protect up to 30% more women from getting the disease. The new test is more accurate and effective, but an abnormal result may mean that you need to have a procedure called a colposcopy, to detect if the abnormality is pre-cancer.
This can be worrying, so to help put your mind at ease, we’ve outlined what you can expect if you are referred for a colposcopy.
The new cervical screening test
In December 2017, the government changed the way we screen for cervical cancer. The Pap test was replaced with the cervical screening test, or the CST. The CST tests for the human papilloma virus, or HPV and is only recommended every five years, instead of every two years with the old Pap test.
HPV is a very common infection and it is usually transferred through sexual activity. In most cases, the immune system gets rid of the infection within six to 18 months. In rare cases where it persists longer, it can turn into a type of pre-cancer known as dysplasia. There are over 200 types of HPV, with 70% of cervical cancers being caused by types 16 and 18 only.
What happens if you get an abnormal result?
If your CST detects the presence of either HPV 16 or HPV 18, then the lab will do a further smear test now called “Liquid Based Cytology or LBC” and you will be referred for a colposcopy. Even if the result is described as ‘higher risk’, it doesn’t necessarily mean you need to urgently have a colposcopy. It just means that the risk of pre-cancer is higher than people who are HPV-negative.
We use national guidelines to triage bookings for colposcopies, based on the grade of the smear result. If it’s high-grade, we’ll book you for a colposcopy within four to eight weeks, for low-grade within eight to 12 weeks and if the smear comes back normal, the booking will happen within 12 weeks.
What is a colposcopy?
A colposcopy is a visual inspection of the cervix with a type of magnifying glass called a colposcope. We apply acetic acid, or medical-grade vinegar, to the cervix to make the cells turn white which helps us see abnormalities. If we need to see even better, sometimes we’ll use a second iodine-based solution which stains normal cells black and abnormal ones yellow.
The procedure takes 10 to 15 minutes and most people don’t experience any pain. However, you may have some discomfort from having the speculum inside your vagina.
If we do see any abnormalities, we’ll take a biopsy to determine if it is cancer or not.
After a biopsy
After a biopsy you may have some pain for a short time. We advise you to avoid rigorous exercise for 24 hours and sexual intercourse for one to two days. Showering is fine but avoid swimming, bathing and spas for one to two days as well. These are precautions to reduce the risk of bleeding or infection.
You might have some discharge and spotting for a few hours afterwards so it’s a good idea to take a thin sanitary pad or panty liner to the appointment.
Treatment of pre-cancer
Abnormal cells on the surface of the cervix are considered to be pre-cancerous. If the biopsy confirms the abnormality is high-grade, there are number of different treatments to make sure it doesn’t turn into cervical cancer.
LEEP, LOOP or LLETZ
LEEP stands for Loop Electrosurgical Excision Procedure and is also known as LOOP or LLETZ. It’s the most common method for treating pre-cancer of the cervix. It involves heating a wire using an electrosurgical generator so that it can cut through tissue like a scalpel. The procedure is usually performed under local anaesthesia in the clinic.
Laser treatment is more commonly used for treating precancerous changes on the vagina and vulva. Occasionally it is used for treatment for cervical precancerous changes.
Cold knife cone biopsy
Don’t be put off by the name, it simply means that a portion of the cervix is removed using a scalpel rather than a hot wire or Laser. We largely reserve this treatment for glandular pre-cancer or where there is a suspicion of cancer.
Recovery and care after treatment
You may experience ‘period like’ cramping following a LEEP procedure. This usually settles down after a short time but if not, painkillers like ibuprofen or paracetamol will help with the discomfort.
You may have a vaginal discharge or spotting for two to three weeks following the procedure which is completely normal and part of the healing process.
We don’t advise that you have sex, use tampons, swim, have a bath or take part in strenuous exercise for two weeks or until the discharge stops. This will allow the area to heal completely and avoid infection.
If you have heavy or persistent bleeding or offensive discharge, speak to your GP or nurse specialist.
Some women may find their menstrual pattern is disturbed. Your next period may commence early, late or be missed completely. It may be light or heavy. If it is significantly heavier and longer than normal, or if you have a second abnormal period, contact your doctor or the clinic.