Screening for cervical cancer is now achieved by a cervical smear test on a 5 yearly basis. The screening programme changed in December 2017 to a more accurate method which tests for the presence of HPV (human papilloma virus). If the virus is present then the test will look at the health of the cells in the specimen as well. Yes a speculum is still needed, but if everything is normal then it will only need repeating in 5 years. If HPV is picked up then the smear test is repeated in 1 year (if the HPV is low grade) or a colposcopy is recommended (if the HPV is high grade)
If pap smears (and later HPV tests) are reported as abnormal by the laboratory then the next stage of investigation is often a colposcopy. This involves looking at the surface of the cervix in more depth with a powerful focused light and a microscope. The cervix is then swabbed with a dilute ascetic acid (like white vinegar) and iodine. These two liquids stain the cervix and help to highlight areas likely to be affected by the HPV virus. We now know that abnormal pap smears, CIN, and cancer of the cervix are caused by HPV (the wart virus that affects the genital region).
A diagnosis at the time of colposcopy is subjective and if there are any affected areas these should be biopsied and sent to a laboratory for a definitive diagnosis and reporting. This report directs the level of surveillance or treatment that is required for each individual. Biopsy is performed under local anaesthetic and typically has little or no down time. Results are usually available 7 days later and require a follow up visit to the doctor for results and a management plan.