Cervical Cancer: Symptoms, Risk Factors & Smear Test Process

Cervical cancer is one of the most common female cancers. Here are the main symptoms, causes and risk factors of cervical cancer, and all you need to know about the smear test process.

7 minute read

Cervical cancer is the 14th most common form of cancer in people assigned female at birth in the UK and around 3,200 new cases are diagnosed every year.

Globally, cervical cancer is the 4th most common female cancer, with an estimated 604,000 new cases and 324,000 deaths from the disease in 2020.

The NHS cervical cancer screening programme aims to detect changes to cervical cells that could become cancerous (precancerous cells) in the early stages of the disease when treatment is more effective and survival rates are much higher.

What is cervical cancer?

Cancer is a condition where body cells behave abnormally and grow out of control, sometimes spreading to other parts of the body. Cervical cancer occurs when abnormal cells develop in the lining of the cervix (the entrance to the womb).

What are the symptoms of cervical cancer?

In the early stages, precancerous cells in the cervix rarely cause symptoms. The only way to detect abnormal cells that may develop into cancer is through cervical screening.

If precancerous cells develop into cervical cancer, symptoms may include:

Abnormal vaginal bleeding such as between periods, during or after sex, or after the menopause
Your period may last longer or be heavier than usual
Pain during sex
Pelvic pain (pain in your lower back or tummy)
Changes in your vaginal discharge such as a strong smell, unusual colour, or an increase in discharge

These symptoms can be caused by other conditions such as fibroids and endometriosis, and do not necessarily mean you have cervical cancer. However, if you have any of the above symptoms, make an appointment to see your GP.

What causes cervical cancer?

Nearly all cervical cancers are caused by an infection with certain types of human papillomavirus (HPV).

HPV is a common sexually transmitted infection (STI) that rarely causes symptoms, but in women, certain strains can cause abnormal changes in cervical cells that can lead to cancer.

Since 2019, the NHS has offered a vaccine against HPV to both boys and girls between the ages of 11 and 14 to help prevent the spread of HPV and reduce rates of cervical cancer.

What are the risk factors for cervical cancer?

Anyone with a cervix can get cervical cancer, but some factors can increase your risk. Risk factors include:

Age - cervical cancer is more common in women under the age of 45
Smoking and passive smoking
A weakened immune system - due to HIV/AIDS, medical treatments like chemotherapy and immunosuppressant drugs, or a medical condition like diabetes or kidney disease
Multiple or early childbirth - having multiple children or children at an early age (under 17 years old)
Your mother took the hormonal medication diethylstilbestrol (DES) while pregnant with you (between 1939 and 1971)
A previous history of vaginal, vulval, kidney or bladder cancer

What is screening for cervical cancer?

Cervical screening (a smear test) is a test to detect the presence of human papillomavirus (HPV) and early changes in your cervical cells.

What does the test involve?

A cervical smear test involves taking a sample of cells from your cervix. The procedure is normally carried out by a female nurse or doctor. They will explain everything that is going to happen during your cervical smear test and answer any questions you may have.

During a cervical smear test:

You will be asked to go behind a screen and undress from the waist down.
Your healthcare provider will ask you to lie on your back on the examination bed with your legs bent, ankles together and knees apart. You’ll be given a sheet to cover your lower half. If this position is difficult or uncomfortable for you, speak to your healthcare provider about trying a different position.
A smooth cylindrical tool called a speculum is gently inserted into your vagina.
The speculum is opened to allow your healthcare provider to see your cervix clearly.
Some cells will be taken from your cervix using a soft brush.
The speculum is closed and removed.

A cervical smear test normally takes less than five minutes, and the whole appointment is usually around ten minutes.

Watch this short video for more information on what happens during a cervical smear test:

What if I’m worried about having a cervical smear test?

Many women worry about having a cervical smear test and may put off or avoid the procedure because of embarrassment or fear of pain. After all, it isn’t a self-test process like it would be for other cancers, such as bowel cancer.

Though you may experience some discomfort during your smear test, the procedure is normally quick and shouldn’t be painful. Talking to the health professional carrying your cervical smear test can help put your mind at rest and let them know how you are feeling.

Remember, you are in control and can ask to stop the test at any time. Some other things you can do to help you feel less worried include:

Bring someone with you for support.
Wear something that covers your lower half during the test, like a long jumper, dress, or skirt.
Take some deep breaths before and during the test or try some breathing exercises to help you relax.
Bring some headphones and something to listen to or read during the test.
If you experience pain during your smear test, tell your healthcare provider. They may decide to use more lubricant or a smaller speculum.

What should I expect after my cervical smear test?

In the hours after your cervical smear test, you may have some light bleeding or spotting. This is normal and normally nothing to worry about.

If you experience heavy bleeding, or the bleeding continues for more than a few hours, make an appointment to see your GP.

Who is eligible for cervical cancer screening in the UK?

In England, everyone with a cervix between the ages of 25 and 64 is eligible for cervical screening. If you are registered with a GP, you’ll receive a letter in the post inviting you to make an appointment.

If you missed your last cervical screening, you do not need to wait for a letter to book an appointment. You can make an appointment through your GP, or sometimes your local sexual health clinic or walk-in centre.

How often do I need to be screened for cervical cancer?

How often you need to be screened for cervical cancer depends on your age.


Age	How often you are invited for screening
Under 25	Up to 6 months before you turn 25
25 to 49	Every 3 years
50 to 64	Every 5 years
65 or above	Only if you had a recent abnormal test result

How often you are invited for cervical cancer screening may vary in other parts of the UK. For more information, check cervical screening in:

How to get your cervical cancer screening results

You will normally receive your test results by letter. You’ll be told at your smear test appointment when you can expect your results. If your test results take longer than expected, call your GP surgery.

What do the results mean?

Your results will tell you if human papillomavirus (HPV) was found in your sample, whether there are any abnormal cells in your cervix, and what happens next. In some cases, your results may be unclear, and you may need to have the test again in three months.

Your result may be:

HPV negative - this is the most common result and means your risk for cervical cancer is very low. You do not need any further tests and will be screened again when you are invited for routine screening.
HPV positive - this means that HPV was found in your sample. There are two types of HPV positive result.
- HPV positive, but no abnormal cell changes - you will be invited for cervical screening in one year.
- HPV positive with abnormal cell changes - you will be invited for a colposcopy, a test to examine your cervix more closely.

Screening for cervical cancer is vital in the detection of abnormal (precancerous) cells, to prevent the development of cervical cancer and diagnose the disease in the early stages.

In the UK, thousands of lives are saved every year through the cervical cancer screening programme. A few minutes of discomfort are a small price to pay for your health and peace of mind.

If you have been invited for cervical screening, make an appointment as soon as possible. If you have not received an appointment, or have symptoms of cervical cancer, make an appointment with your GP.