Understanding the UK Pap Smear (Smear Test) System

This is a recurring topic on UKY, and one which there seems to be some misinformation/misunderstandings about.

Pap smears are called "smear tests" in the UK. When you arrive and register with your local GP, your name will automatically be entered in to the NHS Cervical Screening Programme.

This programme, implemented in 1988, is a national computerised system designed to invite women to be screened, and to follow up their results. Woman are first invited at 25 and remain in the system till age 65.

The intervals are:
Age group (years)   Frequency of screening
25                         First invitation
25 - 49                       3 yearly
50 - 64                       5 yearly
65+                        Only screen those who have not been screened since age 50 or       have had recent abnormal tests

The interval times offered in the UK seem to upset some expats. People used to having a pap smear every year, or those with a history of abnormal smears sometimes feel that having a smear every 3 years is not enough.


If you have had an abnormal smear in the past, please let your GP know. There is also nothing from stopping you from requesting a smear test more often than the 3 year recall if it makes you more comfortable.

You can get your smear test done at several locations.
1. GP's office
2. Regional family planning clinics. These will have a mix of appointment based and walk in clinics. Ask your GP for a local list.
3. GUM Clinic. (Genitourinary Medicine) Ask your GP for the local GUM clinic information. These clinics also do confidential STD and pregnancy testing. Walk in and appointment based.

Remember that the 3 year recall is only for patients that have had a normal history. It gets a bit more complicated if abnormal calls are located.

There are several grades of abnormalities.

1. Borderline changes (aka as ASCUS in the US): This is considered to be a low grade change and in most cases, the patient will be invited back for another smear test in 6 months. If the second smear is negative, the patient will be invited back every 6 months, until 3 consecutive negatives are reached. If that happens, the patient is returned to normal recall. In the event that pre-malignant changes (dyskaryosis) are found on a subsequent smear, the patient may be monitored, or referred to colposcopy, at the GPs discretion.

2. Low Grade (Mild) Dyskaryosis: Patients may be monitored since some low grade lesions do regress on their own, or referred to colposcopy.

3. High Grade (Moderate to Severe) Dyskaryosis: Patients referred to colposcopy for treatment.

4. Malignancy: Very rare since cervical cancer is a slow growing entity. Most patients will have not had a smear test in over 10 years, or perhaps never. In my 15 years in the field, I have seen only a handful of flat out cervical cancer cases.

If dyskaryosis is found on a smear, the patient will then have a yearly recall for 10 years following the first normal smear post treatment. This clock resets itself each time a new abnormality is noted, so no one will be returned to 3 yearly recall without having had 10 years of negative smears. 

I hope that this is a helpful post. The UK system is what it is, and I am not posting any of this to start a debate on which system is *better*. What I can say to you as a professional who has worked in both countries reading the smear tests, is that it was designed to maximise the number of women tested, with the most efficient timeframe, and I am completely comfortable with having my smear test done every 3 years.



More info here: http://www.cancerscreening.nhs.uk/cervical/

Good post. I can concur that having had an abnormal smear in the US and then switching to the UK was not a problem. I've had colposcopies and biopsies, including one under sedation because I'm a total wuss, and my care was excellent.

What might also be worth noting here is that in the US, the yearly smear is often hand in hand with birth control monitoring and will also include a breast exam and ovary exam. It is unlikely you will get that here. I only mention this, not to start a debate, but to point it out since the Just Do It threads are meant to stand as first points of reference.

Good point! I neglected to mention that difference. 

kaiser also is moving to a 3 year system in the US (or so their literature says). I think this is heading towards the norm, though I am sure you can get one every year if you want to.

I had heard Kaiser was thinking about it and I know Medicare will only pay for a smear every 2 years unless there is an abnormal history. I agree that this will probably become more common in the US as insurance companies tighten their belts.

Balmerhon~ I've just reread my post and I hope I didn't come across as not wanting anyone to make comments/additions. What I meant by not statring a debate (and probably worded badly due to my hangover), was that this post is more about presenting the system as it's supposed to work to people who might be a bit nervous about it. Of course there will always be cases where the system fails us, but that is true in every aspect of life. Sorry if I came across the wrong way!

I'd also like to add that my experience with my colleagues in the UK has been very positive. The individuals I have met thus far are every bit as well trained, conscientious, and caring as the folk I worked with in the US.

 

Thank you so much for this!!  I'm under 25, but have extensive family history of reproductive system problems, so I found the UK system a bit confusing & 'not enough', but now that I know what it is & how to navigate, I will feel a lot better about going to my GP.

Courtney, you're post was fine. Comments in Just Do It are just meant to be additionally helpful or just thank yous for the great info. Debate can always be started in other sections of the forum!!

Excellent post, Courtney! 

Thank you so much for this great information, Courtney!  I was quite worried about the system after reading some other stories, but your clear, concise summary really helped ease my worries, thanks! 

(I've always found it ironic that the CDC recommends a PAP smear every two years (after some number of clear annual ones), but the doctors pitch hissy fits if I don't let them do it every single year).

Hi--
just wondering about the general appointments system for a GP. I've tried booking an appointment with mine for a smear test, but basically it sounds like I'll need to take a day off work since they're unable to accommodate my class schedule and actually seemed annoyed that I made any requests for particular times. The prob is, I work at least an hour's drive from where I live, but of course can't register with a GP closer to my workplace even though it would solve a lot of these issues. What do people who are working full time do when they have to make frequent doctor's visits? Is the only option pretty much grab the spot you can and then request that time off work?
Thanks....

Sorry-- I'll repost this in the health forum

Sorry to resurrect an old thread, but I have a question about what I read above.

Balmerhon mentioned that breast and ovary exams are not typically done at a smear test. Are ovaries or breasts checked by any doctor at any time? I've had a history of cysts on my ovaries, and would like to make sure that they are monitored for abnormalities. And while I do not have a history of any breast issues, nor does it run in my family, I am concerned at a potential lack of them being examined.

THANK YOU Courtney! I just talked to my GYN about getting my records. Glad I'll be coming with a copy in hand.

Sorry to resurrect an old thread, but I have a question about what I read above.

Balmerhon mentioned that breast and ovary exams are not typically done at a smear test. Are ovaries or breasts checked by any doctor at any time? I've had a history of cysts on my ovaries, and would like to make sure that they are monitored for abnormalities. And while I do not have a history of any breast issues, nor does it run in my family, I am concerned at a potential lack of them being examined.

You will need to bring up your previous health issues and concerns with your GP/Nurse. If they decide they need to check for any problems they will.

Also, you should be doing monthly breast checks yourself if you aren't already: http://www.cancerscreening.nhs.uk/breastscreen/publications/be-breast-aware.html

Sorry to resurrect an old thread, but I have a question about what I read above.

Balmerhon mentioned that breast and ovary exams are not typically done at a smear test. Are ovaries or breasts checked by any doctor at any time? I've had a history of cysts on my ovaries, and would like to make sure that they are monitored for abnormalities. And while I do not have a history of any breast issues, nor does it run in my family, I am concerned at a potential lack of them being examined.

Tell your GP about your history of ovarian cysts and any problems they have caused you. Ask for a scan and they should refer you to a gyaecologist.

I am speaking from the experience of someone who has extremely large fibroids. I see a gyn at the hospital for scans.

If you have a gynaecological problem - as opposed to just needing routine pap smears, mammograms, birth control or prenatal care - you will be seen by a specialist, if the GP thinks it is necessary.

Actually, that goes for any type of medical condition that needs to be monitored, not just gyn ones.  Let your GP know, and they will refer you to a specialist if they think it is appropriate.