Ask an expert about cervical cancer and cervical screening (UCLH web chat) 

During Cervical Cancer Prevention Week (24-30 Jan) we had Tim Mould, consultant gynaecological oncologist at UCLH, to answer any questions you may have had about screening, treatment options and research. 

Mr Mould treats women at University College hospital and cites his research interests as ovarian, endometrial and cervical cancers. Prevention week was backed by a local campaign to encourage local women to attend screening and to dispel fears about it.   

Look out for more ‘Smear for Smear’ campaign this prevention week in Camden. 

Below is a transcript of the webchat.

Good afternoon and welcome to our web chat. We will begin at 13:00, but you can submit your questions now in preparation for the chat. Please note: your questions will not appear in the main chat window until after 13:00.

Mr Tim Mould will be joining us to take your questions on ‘cervical cancer and cervical screening’ and will try to answer as many questions as possible within the hour long web chat.
1:01 Tim Mould:
Welcome to our web chat on the subject of cervical cancer and cervical screening. My name is Mr Tim Mould - and I am ready and waiting to take your questions.

If there are other questions on other gynaecological cancers , I will be happy to answer them.
1:01 [Comment From Guest: ] 
Are there any symptoms of cervical cancer?
1:01 Tim Mould:
Cervical cancer does cause symptoms normally. The most common are bleeding after sex and an abnormal discharge. Remember that these symptoms have lots of non-cancerous causes too. Cervical pre cancers detected by smear tests do not have symptoms. That is why smears are so important – as we can treat these precancers to stop them ever turning into cancer.
1:01 [Comment From Guest: ] 
How often should you have a smear test?
1:02 Tim Mould:
Smear tests are recommended every 3 years between 25 and 49, then every 5 years between 50 and 64. The smear programme is doing a pilot study of a new system that is likely to be brought in over the next few years. In this system, the first test performed on the smear is an HPV test. If this is positive, then the analysis for the precancerous cells is performed. If this is clear, the test is repeated every year until the HPV is eliminated.
1:04 [Comment From Guest: ] 
Hi, I am yet to have a smear test. Is the myth true - does it hurt?
1:05 [Comment From Guest: ] 
Hi What can a smear test show?
1:07 Tim Mould
Smears involved a speculum examination to see the cervix. This is rather undignified, and not comfortable, but most people tolerated them ok. The smear itself is a little uncomfortable/unpleasant, but only hurts in a small number of people
1:07 Tim Mould
A smear looks for precancer cells. These are tiny abnormalities in themselves, but if they are left to get worse, they can turn into cancer in the future. This normally takes a number of years. The treatment of the precancerous cells is a very simple procedure
1:07 [Comment From Emma: ] 
My mum had cervical cancer. Are my chances higher because of this?
1:08 Tim Mould
Cervical cancer is not hereditary. So if your mum had it, this does not increase your chance of having it
1:08 [Comment From Cassandra: ] 
Hi Dr Mould, my mother has been diagnosed with ovarian cancer, does this make me more likely to get it too?
1:09 Tim Mould
The risk for ovarian cancer for someone without a relative with ovarian is 1.5% lifetime risk.
If your mother has had ovarian cancer, this risk rises to 5% lifetime risk
If your mother has had a high grade serous ovarian cancer, she may be offered a genetic test for the BRCA gene for which she would have a 17% risk with this type of ovarian cancer. If she had this gene abnormality, you would have a 50:50 chance of inheriting the gene. This gene increases your risk of ovarian and breast cancer. It is the gene that Angelina Jolie has.
1:09 [Comment From Guest: ] 
Do women have to have their smear at a GP
1:11 Tim Mould
Good question – like all the questions
Most women have their smears at the GP surgery, but they can be done at a family planning clinic, sexual health clinic or in a hospital. The only problem is that the screening programme seem to be tightening up on the process, so if they receive a smear that is not due, they do not seem to be processing these days
1:11 [Comment From Emma: ] 
I had my smear test last year and it was clear but I have had unprotected sex since then- do I have to wait another few years to get my smear again?
1:15 Tim Mould
See answer above – you will have to wait, but see the answer to the next two questions which should explain that it is ok to wait
1:15 [Comment From JJ: ] 
How long does the cancer take to develop? I recently had my smear and all okay.... but could there be something latent?
1:17 Tim Mould
It is supposed to take 10 years for a precancer to turn into a cancer
Latent….. smears can miss abnormalities. That is why we do them reasonably frequently so if that a smear misses a precancer, it should pick it up next time, before it turns into a cancer
1:18 [Comment From Guest: ] 
Hi. Could you tell me more about HPV?
1:21 Tim Mould
I mentioned earlier that the screening programme team are investigating a new system whereby the first test will be for HPV
HPV is the cause of the precancers that the smear is trying to detect. If someone does not have HPV they can not get the precancer. This means that we have a test that will not miss any abnormalities.
If the HPV test is positive, this does not mean that someone has a precancer, but rather they have a risk of developing one, so the check for the precancerous cells is done, and the process is repeated after a year rather than 3 years

More coming about HPV in a moment ……. I need to rest my fingers for a second
1:23 Tim Mould
HPV is very very common.
There are 120 strains – you start coming across it as a child playing with other children
1:25 Tim Mould
There are 40 strains that are found in the genital area. You start to come across these when you start to have sex. This is pretty much inevitable if you have sex.
The good news is that our body is very good at getting rid of HPV via our immune system. 80% of women will get rid of a new HPV in 12 months, 90% in 2 years, 95% eventually. It is only if the HPV persists and is of certain types that it causes the precancers that can turn into cancer
1:25 [Comment From Jo: ] 
Are there different types of cervical cancer?
1:25 Tim Mould
Yes – the most common is squamous cell cancer, then adenocarcinoma. Then there are really rare ones after that
1:26 [Comment From Carol: ] 
Can you get cervical cancer later on in life after the menopause?
1:27 Tim Mould
Cervical cancer is most common around 35 – hence it is really important for young women to have their smears.
But it still happens after the menopause- hence the smear programme continues to 64
1:27 [Comment From Michelle: ] 
Will I still be able to have sex following a hysterectomy?
1:27 Tim Mould
Yes, sex should be the same after a hysterectomy. Some research trials have shown that sex is better after hysterectomy. This is because the problem that the operation is done for has caused problems with sex eg fibroids or abnormal bleeding
1:28 [Comment From Mary: ] 
Is cervical cancer only caused through sexual activity?
1:31 Tim Mould
If you have never had sex, you should not come across HPV which means you should not get cervical cancer. One of the first research papers about the cause of cervical cancer was a study saying that nuns never got cervical cancer
But before everyone stops having sex, we must remember that our bodies are very good at getting rid of HPV, and with a simple , albeit not particularly nice, test we can find the people who have not got rid of it and make sure they don’t get cancer
1:32 [Comment From Gillian Akers: ] 
Hi, I have stage 2 ovarian cancer. My consultant has planned surgery, but I wonder is it worth trying chemotherapy first?
1:32 Tim Mould
Sorry to hear about your problem. Stage 2 cancer means it is confirmed to the pelvis. Definitely have surgery first. It should be possible to cut it all out, then follow up with chemo
1:32 [Comment From Fiona: ] 
I've developed an itch down below - should I be worried? I'm not sexually active
1:35 Tim Mould
An itch is not a symptom of a cancer, or HPV
It may be due to candida, and respond to something like fluconazole 150mg which you can get over the counter at the chemist
If it persists, see your GP and ask for referral to a dermatologist – preferably a vulval dermatology specialist – if the GP can not see anything or does not examine you
It is not something to worry about, but there are skin conditions that need an expert eye to diagnose, and will not stop causing an itch until they are treated
1:36 [Comment From Seema: ] 
Could my boyfriend know if he has the HPV virus?
1:36 [Comment From Kat: ] 
Are male cancers also caused by HPV?
1:39 Tim Mould
Men have HPV just like women. But it does not cause the same problems.
We hear about cervical cancer a lot and screen for it, because the cervix is particularly susceptible to the virus. You don’t hear about vaginal cancer, even though the virus is there too, because the vagina does not have this area of susceptible skin. Same with penile cancer
1:41 Tim Mould
In view of this, men don’t get tested for HPV
HPV is not part of a sexual health check for women either as it is not regarded as a sexually transmitted disease – it causes no symptoms, no diseases process itself, and most women will get rid of it without ever knowing they had it
So it is sexually transmitted in the sense of close contact, but not an STD

1:41 Tim Mould
My husband and I were both virgins when we married - can I still get cervical cancer?
1:43 Tim Mould
Depends if you believe your husband, and many blokes are economical with the truth!
Also, close contact can transmit HPV – it does not have to mean penetrative sex. So it depends what you mean by virgin
1:43 [Comment From Alice: ] 
I am a lesbian and have never had intercourse - should I go for a smear test?
1:46 Tim Mould
Lots and lots of good questions
Short answer is yes. The reason is a little like the answer above. We can’t guarantee human behaviour. Your partner may have had sexual contact with a man, or another woman who has had contact with a man. Starts to get complicated!
Add to that the info that HPV is transmitted by close contact rather than penetrative sex, you may have come across HPV
1:46 [Comment From Guest: ] 
I missed out on having the HPV vaccine at school. Would it be worth trying to get the vaccine now?
1:48 Tim Mould
Yes, definitely. Particularly if you are not in a stable relationship and may come across a new HPV with a new partner. It is unlikely that you will have come across all the strains protected by the vaccine – if you had done, you would have eliminated them and be immune to them already

More coming on vaccines
1:48 [Comment From Alice: ] 
Was Michael Douglas's throat cancer really caused by HPV then?
1:50 Tim Mould
Michael Douglas smoked like a chimney! This is likely to have been the cause, and he retracted the statement about HPV causing it
More coming on HPV caused cancers
1:50 [Comment From guest: ] 
thank you, I am 43 so should I have the vaccine then?
1:52 Tim Mould
The vaccine still works at 43, or 53 and so on
If you may enter a new relationship, or can’t be sure of your partners behaviour (that’s everyone I think), you should consider the vaccine
Note to all – I am not sponsored by the vaccine company and have no bias to declare
1:55 Tim Mould
HPV can cause cancer of the vagina, penis, anus, throat – but this is very rare
Many people who get these cancers have something else going on eg heavy smokers that add into the HPV
The HPV vaccine Gardasil covers 4 strains including the strains that cause genital warts
A new version is on the way Gardasil 9 which covers 9 strains. This will prevent 90% of cervical cancers. It is approved in the EU and US – we are waiting for it to come to pharmacies now
1:55  [Comment From bethany: ] 
can you survive stage 4 cervical cancer?
1:56 Tim Mould
Yes it is possible. But the more advanced the cancer the more difficult to treat, and the success rate is less. Good luck
1:56 [Comment From Soo: ] 
Are you more likely to have cervical cancer if you have had had children?
1:57 Tim Mould
It is about being unlucky enough to not eliminate the HPV you come across when you have sex, and then unlucky enough for the smear testing programme to catch it as a treatable precancer
1:57 [Comment From Guest: ] 
Are women still able to have children after successful cancer treatment?
1:58 Tim Mould
Depends on the stage
Stage 1b1 and below have surgical treatments where fertility is preserved
1:58 [Comment From guest: ] 
is the vaccine free then for me?
1:59 Tim Mould
if you missed the vaccine programme, you have to buy it
About £100 per shot i'm afraid
You need two shots according to some latest research, 3 shots are the manufacturers advice
1:59 [Comment From linda: ] 
i am 5 months pregnant and have just found out my partner cheated on me - should I have a smear test done?
2:02 Tim Mould
No - no need to panic. It will be fine
If you are worried about HPV, remember young women often (80% students, 50% 24 year olds) have HPV and young women are the ones having babies. Babies are very resistant to HPV and handle vaginal delivery very well
2:02 [Comment From Guest: ] 
Does weight have any influence?
2:02 Tim Mould
not with cervix cancer
Breast and endometrial are the ones where weight is a factor
2:02 [Comment From guest: ] 
why is the price so high if saving lives?
2:03 Tim Mould
good question
2:03 [Comment From Julie: ] 
Although I have two children and had straight forward births, with no physical or pychological problems - i hate smear tests.Just thinking about them makes me shudder! The last couple of times my blood pressure fell through the floor - and both times I completely fainted -much to the dismay of the nurses! Do you think I could ask for a sedative?
2:05 Tim Mould
well done for having them as it sounds you have a horrid time.

Tricky question

not sure about the sedative

Best thing would be to have an HPV test - this can be done from around the cervix rather than the cervix itself, and if clear, you would not need to repeat for 5 years
2:06 Tim Mould
Thanks for the questions - hope the answers were helpful

I'm signing off now

Best wishes

Tim Mould

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