The importance of cervical cancer awareness

17th – 23rd January 2022 marks Cervical Cancer Prevention week. We’ve joined forces with the experts, bringing you this guide, to raise awareness of cervical screening. If you have a cervix, this one is for you.

Here, Dr Deborah Lee from Dr Fox Online Pharmacy talks about the importance of not delaying cervical screening when invited but also to see if there was anything we could be doing to avoid this type of cancer.

Did you know?

  • There are around 3,200 new cases of cervical cancer each year in the UK.
  • Cervical cancer is the 14th most common cancer in the UK.
  • Cervical cancer can be prevented by having regular cervical smears.
  • The most common age group for women to be diagnosed with cervical cancer is in women aged 30-34 years.
  • Since the 1990s, the incidence of cervical cancer has fallen by around 25%. This is likely to be due to the success of cervical screening.
  • The number of cases of cervical cancer is predicted to fall in the coming years due to the success of HPV vaccination.
  • Around 850 women still die each year in the UK from cervical cancer.
  • Since the 1970s, the death rate for cervical cancer has fallen by around 75%. Again, this is likely to be due to the advent of cervical screening.

Risk factors for cervical cancer

HPV – 99.8% of cervical cancers are due to infection with the Human Papillomavirus (HPV). This is a sexually transmitted virus. There are over 100 subtypes. HPV 16 and 18 are high-risk subtypes, and these are the target of the current HPV vaccination campaign. Low-grade HPV subtypes, including those which cause many visible genital warts, are not a risk factor for cervical cancer.

Many women with HPV infection never develop cervical cancer, meaning other factors are also important for the infection to progress. Cervical cancer is more common in those who also had an early age of first sexual intercourse, before the age of 14, or who have had 6 or more sexual partners. Cervical cancer risk is lowered in women whose sexual partner has been circumcised.

Women with genital herpes are also at an increased risk of cervical cancer.

Smoking – 21% of cervical cancers are attributed to smoking. The risk of cervical cancer is increased by 46% in current smokers as compared to lifetime non-smokers.

HIV –  Cervical cancer is six times more common in those infected with the Human Immunodeficiency Virus (HIV). However, this risk is significantly reduced in women who are taking highly active antiretroviral therapy (HART).

Family history – The risk of cervical cancer is 74%-80% higher in women with a first degree relative, such as a mother or a sister who has had cervical cancer, suggesting there may be some genetic susceptibility.

Oral contraceptives – Up to 10% of cervical cancers are thought to be associated with the use of oral contraceptives. However, the risk is only attributable after five years or more of use. There is no need to panic and stop taking the pill. The benefits of taking the pill are considerable and should not be underestimated. Pill users should not be unduly concerned but are strongly advised to attend for their cervical smears regularly, and to try not to smoke.

Ethnicity – Cervical cancers are more common in ethnic groups who are reluctant to come forward for screening. This means cervical cancer is more common in women who are Black, Hispanic, Asian or from low-income households.

Women who were given diethylstilbestrol (DES) – Some women were given DES, a potent synthetic estrogen, between 1940-1970,  to try and prevent miscarriage. This is known to increase the risk of cervical and vaginal cancers.

The UK Cervical Cancer Screening Programme

One important aspect of cervical cancer is that it has a very long premalignant phase, during which it is possible to identify abnormal cells – by having a cervical smear. These abnormal cells can then be treated. Doing this prevents these cells from transforming into cervical cancer cells.

The NHS Cervical Cancer Screening Programme was started in 1988, and since then there has been a dramatic fall in the number of cases of cervical cancer.

Adult women aged 25-64 years are invited to have a cervical smear once every 3-5 years in the UK. Those aged under 50 are asked to come once every 3 years, and those aged over 50, every 5 years. Trans men (who were female at birth) are not automatically invited but can request a cervical smear if they still have a cervix.

The smear itself is also tested for the presence of HPV. If HPV is present, you will be invited to have smears more often, or referred to colposcopy, where your cervix can be examined more closely with the aid of a special instrument called a colposcope. This gives magnified images of the cervix.

What is a cervical smear?

cervical smear

A cervical smear is a simple test, in which a plastic spatula is gently rubbed over your cervix (the neck of the womb) to collect some cervical cells. These are then sent to the lab to be looked at down the microscope.

To be able to do this, the doctor or nurse taking the smear, needs to see your cervix. This means you do have to remove your underwear, lie on the couch, and allow them to insert a vaginal speculum. This is an instrument, made of plastic or metal, which looks like a duck’s beak.

The secret is to try and relax as much as you can. This helps the smear taker to be able to manoeuvre the speculum as they need to, to get a good view of the cervix. Try not to get too anxious. Doctors and nurses who do smears are very well trained and will do all they can to put you at your ease. It can be uncomfortable having a smear, but it shouldn’t be painful. It usually only lasts – perhaps 30-60 seconds. This is a very short inconvenience for a test that could save your life. You can watch a video of how a cervical smear is taken here.

How many women have not had a cervical smear?

It is very worrying that in 2019, 1 in 3 women aged 25-64 had not had a cervical smear. In a survey conducted by Jo’s Cancer Trust, 2000 women were asked about their experiences of having a cervical smear. An incredible 915 had either never had a smear or had delayed an appointment to have one. 71% said they felt scared, 75% felt vulnerable, 81% were embarrassed, and 67% said having a smear would make them feel out of control. 58% were scared it would be painful.

Having taken cervical smears for over 30 years, I can tell you, taking a smear is a straightforward process, that for the vast majority of women, is easy, quick, and almost painless. The smear taker will respect your dignity, cover you with a blanket, ask permission to start the procedure and stop at any time if you ask them to stop. You do not need to feel out of control. Doctors and nurses who work in sexual health or GP surgeries, spend all day looking at female vulvas and vaginas – they are perfectly used to it, and nothing will surprise or shock them. You can feel completely at ease with these medical practitioners. Any female doctors or nurses will no doubt have had a smear test themselves and know how it feels.

What is far more of a worry, is not attending for your smear, but having to come to the clinic in the future, with a possible undiagnosed cervical cancer.

Getting your smear results

cervical cancer

You should get a letter in the post about your results, usually within 4 weeks. If your smear is normal, you will be told to have another smear in 3-5 years depending on your age. Sometimes, there may have been difficulty interpreting the smear, and it just needs repeating in 3 to 6 months. If you do have abnormal cells, you will be referred to the Colposcopy clinic so a Gynaecologist can take a closer look at your cervix. If HPV is present, but your cells look normal, you will simply be asked to have another smear in 12 months. The important thing is to follow instructions and attend for your subsequent visit as requested.

How accurate are cervical smears?

It’s important to remember that no tests are ever 100% accurate. There is always a small chance the smear could show an abnormality that isn’t cancer, or, could be wrongly classed as negative, meaning something abnormal was missed. In between smear tests, if you have any symptoms such as bleeding in between your periods or after sex, or abnormal vaginal discharge, it’s important to see your GP or go to the Sexual Health clinic without delay.

Prevention is better than cure

After a detailed look at the statistics, experts believe that for a woman aged 33 – 64, attending for cervical screening will reduce her chance of developing cervical cancer over the following five years, by 60-80%, and reduce her chance of advanced cervical cancer by 90%. However, cervical screening is less effective in younger age groups. In general, doing cervical smears in women under the age of 25 has not been found to be beneficial.

If you have any concerns about your smear test, you could book an appointment with your GP or practice nurse, just to discuss the situation and take a list of written questions. They will be happy to help you. You can take a friend or relative to your smear appointment with you.

You can also ask for a doctor or nurse of the sex of your choice to take your smear, although you may be asked to come back on another day if this can’t be actioned at the same visit.

You will also be offered a chaperone when you have your smear. You can accept or refuse – some people prefer another person there to hold their hand, while others prefer as few other people in the room as possible.

Try and find out all you can about having you smear before you get to the clinic. Knowledge is power, and it will help you feel more confident. For example, take a look at Jo’s Trust – Cervical Screening.

What can you do to reduce your risk of cervical cancer?

You can have a smear at any time so long as you are not bleeding. In the past, smears were preferable around midcycle – on day 14 – but these days this is rarely needed. If you are on a form of hormonal contraception, you will not be ovulating anyway, and will not have a day 14. This might be needed in older women, who are having natural cycles, if it has been hard to get enough cells on the smear in the past. But don’t let the day 14 issue confuse the situation.

If you are aged 40 plus, and find smears uncomfortable, you might benefit from using some topical estrogen in the vagina for 4 -6 weeks before your smear test. Ask your GP or the sexual health doctor or nurse about this. You do need to stop using the cream or pessaries at least 2 days before the smear test.

HPV vaccination

In the UK, HPV vaccinations are offered to girls and boys aged 12 and 13, when they are in year 8. They then have a second dose 6 -24 months later. The idea is to create HPV antibodies before they become sexually active and encounter the HPV virus through normal sexual activity. HPV causes cancer of the cervix, vulva, vagina, anus, penis, as well as some head and neck cancers.

Between 2009 and 2018, over 10 million doses of the HPV vaccines were administered. The vaccines have been proven to be safe and highly effective. In a recent 2019 study, which included over 66 million young men and women, HPV vaccination showed an 83% reduction in high-risk HPV in teenage girls and a 66% reduction in women aged 20-24. There was also a 51% reduction in precancerous changes to the cervix in teenage girls and a 31% reduction in women aged 20-24.

Don’t smoke

cervical cancer

Some studies suggest the viral load of HPV is higher in the cervix of women who smoke than in non-smokers. The reasons for this are not well understood, however, a toxin in cigarette smoke known as Benzo[a]pyren has been shown to stimulate HPV multiplication.

Protect yourself from HPV by using a condom

Consistent and careful use of condoms can help prevent the acquisition, not just of HPV infection, but also other STIs. It can also help cause regression of abnormal cells if they are present on the cervix. However, having sex with an HPV  infected partner, even once,  without a condom, is likely to result in the transmission of infection. Most UK adults will be infected with HPV at least once in a lifetime.

The best sexual health advice at present is that women should use a condom for STI protection as well as, not instead of, a reliable method of contraception to prevent an unplanned pregnancy. If a male partner will not use a condom, women do have the option of using the female condom, the Femidom.

Cervical cancer is linked to an increased number of lifetime sexual partners. For good sexual health, you should try to avoid multiple partners , or overlapping partners, as this is associated with increased risk.

References:

Gov. UK

Cervical screening NHS

HPV NHS

The Guardian

University of Oxford

US National Library of Medicine (National Institutes of Health)

National library of medicine

Helen Baker founded and runs  We Are All Smear Ready, a craftivism campaign to raise awareness of the importance of cervical screening and addressing the barriers of body image and embarrassment, two of the main barriers to attending appointments. She says;

‘With body image and embarrassment being two of the main barriers to attending a smear test, this Craftivist campaign spreads the message that you don’t have to be beach ready to be smear ready, we are all smear ready. It really doesn’t matter how your lady garden looks, nurses have seen all varieties and don’t care what yours looks like.

With so much focus on the external aspect of our bodies we can often overlook how important it is to look after our bodies internally but these mini handcrafted pants as a gentle reminder that cervical screening and HPV vaccines are the best ways to protect yourself from cervical cancer. By making and sharing mini pants and boxers during Cervical Cancer Prevention Week, we can help to spread this important and potentially life-saving message to anyone with a cervix.’ 

You can follow her campaign here

When was your last screening? Join in the conversation by commenting below or following us on Instagram.

Living with BRCA1: From ticking time bomb to taking action

It’s been almost 6 months since I tested positive for the BRCA1 gene mutation. That means six excruciating months of living with BRCA1 feeling like a ticking time bomb and being at worryingly high risk of developing breast or ovarian cancer – may be both – over my lifetime, maybe over the next couple of years. Who knows? I don’t have enough women in my family to know how this could play out for me.

After spending a couple of months in denial, I went into a total research frenzy. I became obsessed with finding out the answer to everything about my new mind-bending prognosis to make sense of this crazy world of living with BRCA1. I had so many questions and thoughts on repeat in my brain it was utterly exhausting and overwhelming. Every spare minute I had I was lurking around in BRCA Facebook support groups and BRCA threads in cancer charity forums, feverishly devouring other women’s stories of their BRCA journey and their version of living with BRCA1 – the good, the bad and the ugly.

With every story, I anxiously weighed up my options, which I began to realise were not as many as I had hoped for a woman in her 40s in this day and age.

As I write this, I already have a 1 in 100 chance of developing breast cancer anytime now and that gives me the cold sweats just thinking about it. I know I need to trust myself, have courage, and blow this baby wide open.

Living with BRCA1

Living with BRCA1: No easy magic bullet

After countless conversations, I began to realise there is no magic bullet here other than to have preventative surgery. At my appointment with the Genetics team at The Royal Marsden to which I turned up still clutching at the hope that I wouldn’t have to have my ovaries and breasts removed dissolved quickly. The brutal reality of what I was dealing with smacked me right in the face.

Any noninvasive treatment using PARP inhibitor drugs in a preventative manner that might suppress the faulty gene expression instead of ops was at the very least five years away. At the moment they are only used for actual cancer treatment and are at the time of writing not even in the early trial phase for preventative treatment. Even if I got onto a trial, there is no guarantee that I would then be given a placebo. And of course then I would also have to sit and twiddle my thumbs for a number of years, by which time I could have already developed cancer. And that is not a chance I’m willing to take. Ultimately I began to realise my options were:

  1. Go through the excrutiating pain of taking a wait and see approach of being monitored for breast cancer through regular MRIs, mammograms and freaking out every time I thought I found a lump in one of my breasts. Note, there is no effective screening process for ovarian cancer. So that basically means just waiting to see if and when the cancer shows up and then having to deal with it and the potentially horrific treatment that fighting cancer involves. Thanks but no thanks.
  2. Taking place in The Protector Study to have just my fallopian tubes removed because it’s estimated that around 70% of ovarian cancers start there. I was seriously tempted by this but at already 41 years of age and most ovarian cancer risk presenting itself from age 45, I felt I didn’t really have the time to be messing around with this one. Ultimately I would need to have my ovaries removed in the end anyway and this felt like simply delaying the inevitable….
  3. Having my ovaries removed, my breasts removed and the reconconstructed. The full shebang. Jesus.
  4. Put my faith in alternative approach mainly through lifestyle, diet and herbs and supplements known to have cancer suppressing properties. Ultimately I was just not willing to put my eggs in that basket – as big an advocate I usually am of the natural approach – when essentially my life was on the line.
Living with BRCA1

Step up number three

I knew that whichever way I sliced it, the only option to help keep me cancer-free, alive and well would be number three.

So now I spend my free time looking at pictures of reconstructed boobs convincing myself that I will be ok with my future double mastectomy and reconstruction, that the scars will not be too bad and if they are, that I will try to turn them into something positive by having an artistic tattoo inked over them.

I am also shit scared of the hormonal mess that may ensue from having my ovaries removed – even with HRT which doesn’t mean it will all be rosy. I’ve been there before when I had a total thyroidectomy due to precancerous cells in my thyroid and it was not pretty let me tell you. So I’ve booked an appointment with hormone specialists at The Marion Gluck Clinic to start that conversation and get the best advice I can get.

I’ve also been really lucky to find a couple of amazing BRCA positive role models in my personal network who have been there done that and are helping me to deal with all the things I am so scared of. Questions like will I still be the same person? Will I still like myself? Will it affect my confidence? Wow about my libido and sex?

In the final analysis, it is a big thing having two things massively associated with your womanhood removed, and it is that at the moment that I’m finding the hardest to come to terms with. But then when you stack that up against cancer….well, how could I be so vain? But there it is.

Living with BRCA1: So what’s my game plan?

Right now, I’m waiting for my breast MRI results, hoping that there isn’t something lurking there already. And my rebooked mammogram- because I bloody well got pinged and had to go and take a PCR test which scuppered my previous appointment – is now ticked off. And so I wait.

Once I’ve had those results and know what I’m dealing with, I’ll be able to move forward. My plan is to immerse myself in the Christmas festivities and live life to the max with as much joy as I can possibly cram into it, then come January it’s time for shit to get real. I need to push the button and say I want to move forward with the procedures and stop cowering behind the sofa, starting with the oophorectomy (that’s ovaries removed to you and me love). I know I can do this, I’ve got to be fierce, a previvor, and do it for all those women who never got a chance to do so. I’m doing it for me, my daughter, my family, and for every woman who never made it this far.

Woman photo , People photo created by wayhomestudio, Ribbon photo created by rawpixel.com – www.freepik.com

I tested positive for the BRCA1 gene mutation and here’s how I felt

From a young an age as I can remember, I was always aware that my family was riddled with cancer. Practically every other person in my dad’s family had been marred by it, and both my paternal grandparents had died of it. But until I hit my 4th decade, all of this seemed like something fuzzy and distant that didn’t really apply to me. I didn’t even know what the hell the BRCA1 gene (otherwise known as a tumour suppressor gene), so why should I care.

Oh my dear father

Then last year, due to the fact that my dad had to have a couple of melanomas removed, pieces were starting to be put together. Despite the BRCA1 gene not being linked to melanoma, the medics started paying attention to our family history of cancer, and so did I.

My father was sent for genetic testing. For some reason I still felt a bit detached from what was going on. Even as he told me that he had tested positive for the BRCA1 gene mutation, I still felt pretty nonchalent about the whole thing. After all, about 1% or 1 in 100 men who carry BRCA1 develop breast cancer. Some studies suggest there may be a slight increase in the risk of prostate cancer, but this is not conclusive.

But then the penny dropped

…as I realised that I would have a 50% chance of having the BRCA1 gene mutation, and so at a flip of a coin, my breast and ovarian cancer skyrocketed. Women with the faulty BRCA1 gene, for example, have a 65 to 79% lifetime risk of breast cancer and a 36 to 63% risk of ovarian cancer before the age of 80.

In the back of my mind, I guess I already knew I would have the mutation. I had my thyroid removed due to the discovery of pre-cancerous cells around ten years ago (there is evidence to show a link between thyroid cancer and the gene mutation). But still I remained calm, until I had my pre-test consultation where the harsh reality of a worst case scenarios double mascetomy and having my ovaries ripped out came and smacked my full throttle in the face. But what really got me? That if I did test positive, my daughter would then also have a 50% chance of having the mutation that would then also put her at risk. That’s when the tears started pouring.

Fast forward on a couple of weeks

I saw the letter from The Royal Marsden on my door matt. I wasn’t ready for the results yet. I left it on the stairs for another week. My sister got in touch to tell me she was negative, and right then I knew – I would be that other flip of the coin, the loser in this game of genetic russian roulette.

I prepared myself mentally. I opened the letter, and there it was. As I had suspected all along, I was positive.

I slid into a dark mood

For a few days, I needed to wallow. I didn’t really want to talk to anybody about it. I just needed to process everything. Although I knew I was priviliged to have this information because I would now be on watch and routinely screened, I reeled from the injustice of it all. Hadn’t I had enough shit with my existing health conditions? The total thyroidectomy and the hormonal calamity it unleashed on my body for years after? The metabolic carnage I experienced as my system reeled from a rare condition usually found in diabetics (of which I am not) called reactive hypoglycemia? And now this shadow hanging over me.

And then there was my daughter. Already the letter was urging me to have her tested, at eight years old. I just couldn’t fathom telling her, of passing on this burden to her, and why should I at some a young and beautifully innocent age?

Then a chance to rewrite the script

And then I realised. This thing has been in me all along. And this is my chance to rewrite the script. To get tested, to live life to the fullest because who knows what might happen when. To break out of this dumbed down and restricted Covid sleepwalking state we have all been stuck in for far too long. To cut out meat and dairy from my diet as I had increasingly been trying to do. To stay fit and healthy. And to not let other people’s shit stress me out. All lifestyle factors which can play into the hands of the risk lying within.

I can’t change things the results, but I can change what I do with them and how I approach it all. I either let this weigh me down like an Albatross round my neck, or I use it as a force for good, and remember that I am one of the privilged few to have this information. Because after all knowledge is power, power is wisdom, and I’m going to use that wisdom to change my life for the better.

Photo by Anna Shvets from Pexels, Brett Sayles from Pexels