Everything you need to know about smears

A few weeks ago, I was really scared. After taking a self-test for the early detection of cervical cancer, I received a letter stating that I was HPV-positive and that there was a chance that abnormal cells were developing. So, I had to go to the doctor to get a new smear test to see how those cells were behaving. I had to wait a week for that appointment, and of course, horror stories fly around your head during that week. Unpleasant tests, treatments, bad results, and saying goodbye to your wish for children, I saw it all. Until I spoke to my doctor, who indicated that many people are HPV-positive at some point in their lives and that it doesn't always mean it will develop into something bad. The chance is quite high that your body clears this up on its own. Feeling reassured, I left the practice, and a week later, I was happy to hear that everything looked calm and normal. Still, it made me think: I would have saved myself a lot of stress if I had known a bit more about this beforehand. That's why I now like to lay out all the facts, so that you can go to your smear test with ease next time.

From this year, you will automatically receive a self-test sent to your home.
A shocking 55 percent of women participate in the screening program. That's too little, according to D66. The party came up with the idea to automatically send every woman a self-test when she is called for the screening, hoping to encourage more women to participate. If the test shows that you have HPV (human papillomavirus), as happened to me, you still have to go to the doctor. HPV is the virus that can cause cervical cancer.

PAP 1, 2, 3, 4, and 5
If you receive the result that you are HPV-positive, it will be investigated to what extent this has caused abnormal cells that may indicate a precancerous stage of cervical cancer. Even if you have your smear test done immediately at the doctor's, this will be investigated, as you do not yet know whether or not you are HPV-positive. The gradation of this is indicated in the form of PAP 1, 2, 3, 4, or 5. Below you can see what those results mean.

PAP 1
This is the normal cell appearance. No abnormalities are seen. If you are also not HPV-positive, you will be invited again for the screening in five years. If you are HPV-positive but have no abnormal cells, you need to come back in a year to see how things are at that time. Only if symptoms arise, such as abnormal bleeding, is it advisable to have a smear test done earlier.

PAP 2
A few cells look different than normal. This often resolves on its own. You will be called back after six months to have a new smear test.

PAP 3A
A small cell abnormality is visible. You will be referred to a gynecologist for further investigation.

PAP 3B
The cells are slightly more abnormal than PAP 3A. You will be referred to the gynecologist. Usually, treatment is needed.

PAP 4
At this stage, the cells are even more abnormal. There is a high chance of treatment.

PAP 5
This score indicates that there are very abnormal cells and that research and treatment are needed in the short term. There may be cervical cancer.

Vaccination
You can get vaccinated against the HPV virus. Since 2022, boys and girls who turn 10 years old receive an invitation to get vaccinated against HPV twice. The second vaccination is given six months after the first. All boys and girls automatically receive an invitation from the youth health care. In 2022 and 2023, all young people up to 18 years old (born between 2004 and 2011) who have not yet had an HPV vaccination are invited to get vaccinated. They will automatically receive an invitation for this. These HPV vaccinations are free. In 2023, all young adults born between January 1, 1996, and December 31, 2003, will automatically receive an invitation from the GGD in their region. They can then make an appointment for a vaccination at www.hpvafspraak.nl.

Please note: this vaccination does not fully protect against an HPV virus infection. After vaccination, the body produces antibodies against HPV-16 and -18, and also a bit against a number of other HPV types. The vaccine protects about 95 percent against long-term HPV infections with types 16 and 18, and thus protects against forms of cancer caused by HPV. Research from Britain and Sweden has shown that an HPV vaccine provides up to 87 and 88 percent protection against cervical cancer. Because the vaccine does not provide 100 percent protection, it is still advisable for women to have a smear test done when they are called for it.

Getting vaccinated later
The vaccination works best if you do not yet have an HPV infection. It is therefore important that you receive the vaccination before you become sexually active, but even if you are already sexually active, the vaccination can prevent HPV cancer. Are you over 18 years old and still want to get vaccinated? Discuss this with your doctor.

Sources: Linda, Womens Health, RIVM