Colposcopy and Cervical Screening: Purpose & Procedure

In Hong Kong, cervical cancer is the seventh most common cancer among females and accounts for roughly 3.2% of all new cancer cases for women in 2020, showing a decrease in cases compared to 3.3% since 2016 ^[1]. Besides practising safer sex and getting the HPV (Human Papilloma Virus) vaccination, attending regular cervical screenings is the best option for lowering your risk of developing cervical cancer ^[2]. 

Although many women already schedule regular Pap smears, colposcopy is another form of screening you should be aware of. To fully educate our patients about the benefits of cervical screenings, our blog walks you through everything you need to know about cervical screenings, particularly colposcopy. 

Why should you get regular cervical screenings? 

Regular screenings are vital in protecting yourself from any cancer ^[3]. Detecting an abnormal cell change early on can mean better monitoring and access to effective treatment. This minimises the chances of the problematic cells to turn cancerous, such as cervical cancer. Regular screenings are significant for cervical cancer, as symptoms are less apparent early on. Symptoms may not be present until cancer has advanced ^[4]. 

Who needs cervical cancer screening?

The Hong Kong Department of Health’s Cervical Screening Programme (CSP) ^[5] recommends that women aged between 25 and 64 undergo a screening every three years.

'At a minimum, sexually active women should start having smears done from 25 years old onwards'

OT&P Obstetrician Dr Zara Chan

You should also get regular cervical screenings if you’re:

• A healthy woman who has no symptoms; 
• A woman who no longer gets her period; hasn’t had sex for many years; or has had sterilisation;
• A woman aged below 25 years old who has had sex (or been exposed to other risk factors such as multiple sex partners, smoking or weakened immunity).

It is essential to spread awareness that while the HPV vaccination is beneficial and protects against nine HPV types, current vaccines cannot offer full protection. Screening is still the most important method of cervical cancer prevention.

If you’re unsure whether or not you should receive a cervical screening, you should seek advice from your doctor. 

What is included in cervical screening?

Cervical screening performed regularly without any previously detected abnormalities usually includes a simple cervical smear (also known as a Pap smear). Pap smear is a simple test to detect abnormal cell changes in the cervix and only takes a few minutes. The cells are wiped from the cervix gently by a doctor or nurse with an instrument called speculum inserted into the vagina. 

What is a colposcopy? 

Since 2004, the HK CSP has recorded 92.9% of smear results as negative for ‘intraepithelial lesions’ or ‘malignancy’ while 6.3% of results were abnormal. Your doctor may refer you for a colposcopy because of abnormal smear results, genital warts, persistent vulval or vaginal discomfort, or if they repeatedly fail to obtain an adequate smear sample from the cervix so that they can further diagnose any problems. 

A colposcopy is a diagnostic procedure where the cervix (opening of the womb), vagina and vulva are examined in detail with special solutions and a microscope. This view is greatly enlarged and allows the doctor to examine the cervix in detail. 

A colposcopy will be able to inform the doctor (and you) whether the abnormal smear result is due to HPV infection, or cellular abnormality such as CIN (cervical intraepithelial neoplasia) [10]. 

How is a colposcopy different from a Pap smear?

A colposcopy is a lot like getting a Pap smear, the main difference being the tools used to perform the examination [11]. A Pap smear involves your doctor collecting cells from your cervix using a brush or spatula, but in a colposcopy, your doctor will use a special magnifying instrument called a colposcope. Both screenings usually take around 10–15 minutes to perform. 

What you can expect during your colposcopy

An experienced doctor performs the colposcopy and is a day procedure. In some cases, it can be done by a family doctor who is familiar with gynaecological check-ups.

Once the magnifying instrument, or colposcope, provides a clear view of your cervix, your doctor will look through the lens to identify any abnormalities. They may apply a special solution to the area, as it helps to highlight any suspicious cells. The solution can sometimes be slightly uncomfortable and cause a burning or tingling sensation. 

What is a cervical biopsy?

If suspicious cells are identified, your doctor will want to take a tissue sample (a ‘biopsy’) to send for further examination at a laboratory to confirm what they see. If your doctor does not identify any suspicious cells, the results of your colposcopy can usually be relayed to you during your appointment. If you’ve had a biopsy, your doctor will let you know when your results can be expected. 

After your colposcopy, you can usually return home immediately and resume your normal activities, but some women prefer to rest until the next day. If you’ve had a biopsy, you may have temporary vaginal discharge or light bleeding [12]. This will be normal and should stop within a few days. You should also wait until the bleeding stops before having sex, using a tampon or any lubricants and creams. Speak to your doctor if you’re in doubt.

Preparing for a colposcopy

Your practitioner will educate the patient about the steps they suggest before a colposcopy on a case-to-case basis. Other recommendations usually include stopping the application of vaginal medicines or creams for 24 to 48 hours before a procedure. Moreover, it is often advised to pause vaginal sexual activity and use tampons for one or two days before the procedure. It is best not to insert any products in the vagina during this period. 

Colposcopy can be performed at any stage of the menstrual cycle, but your doctor may ask you about the time of your last period before the checkup to schedule an optimal time. If you experience heavy bleeding on the day, you can call your healthcare provider and request rescheduling. Moreover, you should let your doctor know if you’re pregnant or might be pregnant. In the case of cervical biopsy, you should feel free to discuss a recommended pain management method before your appointment.

What if my colposcopy results show an abnormality? 

For some women, the smear and colposcopy results may show a more severe abnormality, and your doctor may want to perform a LEEP (Loop Electrosurgical Excision Procedure). 

What is a LEEP?

A LEEP is a type of treatment that prevents cervical cancer by removing abnormal cells from your cervix. It involves using a small electrical wire loop to remove the cells and is usually done in a hospital to reduce the risk of infection. 

You may feel discomfort during your LEEP; however, most women don’t feel much as your doctor will apply numbing medicine to the area. After the procedure, some women opt to stay overnight, but the surgery can also be done during the day. 

Although the abnormal cells are removed, it is important to continue doing smears afterwards to detect any future changes!

OT&P Obstetrician Dr Zara Chan

 

Protecting yourself against cervical cancer

While regular cervical cancer screening is the most effective way to prevent cervical cancer, you can also lower your risk with the following preventive measures: 

• Practice safe sex to reduce the chance of getting HPV infection and sexually transmitted diseases  
• Do not smoke cancerous nicotine products such as cigarettes and e-cigarettes
• Get HPV vaccination before being sexually active 
• Spread awareness about cervical health among women around you to lower the risk of others

OT&P Advice

Colposcopy can be described as an in-depth gynaecological check. And although getting an abnormal result can be worrying, you must continue undergoing cervical screenings. It cannot be stressed enough that regular screenings are instrumental in detecting cervical cancer early, so that it can be addressed promptly. 

If you want a cervical screening or for more advice about cervical health in Hong Kong, OT&P gynaecologists are highly skilled and knowledgeable to help with any issues. Book an appointment or get in contact with us today.

References

1. Centre for Health Protection, Department of Health - Cervical Cancer. (2020). Retrieved January 06, 2021, from https://www.chp.gov.hk/en/healthtopics/content/25/56.html
2. Cancer Expert Working Group on Cancer Prevention and Screening. (2014). Recommendations on Prevention and Screening for Cervical Cancer For Health Professionals. Retrieved January 06, 2021, from https://www.chp.gov.hk/files/pdf/cervical_cancer_professional_hp.pdf
3. Centers for Disease Control and Prevention. (2020, July 29). Cancer Screening Tests. Retrieved January 06, 2021, from https://www.cdc.gov/cancer/dcpc/prevention/screening.htm
4. NHS. (2018). Cervical Cancer Symptoms. Retrieved January 06, 2021, from https://www.nhs.uk/conditions/cervical-cancer/symptoms/
5. Cervical Screening Programme Department of Health: 衞生署 子宮頸普查計劃. (n.d.). Retrieved January 06, 2021, from https://www.cervicalscreening.gov.hk/
6. Cervical Cancer - Risk Factors. (2019, June 10). Retrieved January 06, 2021, from https://www.cancer.net/cancer-types/cervical-cancer/risk-factors
7. The Hong Kong College of Obstetricians and Gynaecologists. (2016). Guidelines for Cervical Cancer Prevention and Screening. Retrieved January 06, 2021, from http://www.hkcog.org.hk/hkcog/Download/Cervical_Cancer_Prevention_and_Screening_revised_November_2016.pdf
8. Centre for Health Protection. (2019). Cervical Screening Programme. Retrieved January 06, 2021, from https://www.cervicalscreening.gov.hk/common_files/resource/english/files/booklet_eng.pdf
9. Cervical Screening Programme. (2019). Cervical Screening Programme Annual Statistics Report 2019. Retrieved January 06, 2021, from https://www.cervicalscreening.gov.hk/english/sr/files/sr_statistics_stat.pdf
10. Family Health Service. (2017). Diagnosis by colposcopy: Low-grade Squamous Intraepithelial Lesion (LSIL) / Human Papilloma Virus (HPV). Retrieved January 06, 2021, from https://www.fhs.gov.hk/english/health_info/woman/492.pdf
11. Wilson, D. R., PhD, MSN, RN, IBCLC, AHN-BC, CHT, & Smith, L. (2019). Pap smear: What is it, what happens, and results. Retrieved January 06, 2021, from https://www.medicalnewstoday.com/articles/311995
12. NHS. (2019). Colposcopy. Retrieved January 06, 2021, from https://www.nhs.uk/conditions/colposcopy/what-happens/
13. Hibbs, S. (2019, June 13). Colposcopy: How to Prepare and What to Know. Retrieved January 06, 2021, from https://www.cancer.net/blog/2019-06/colposcopy-how-prepare-and-what-know
14. Planned Parenthood. (n.d.). What is a Loop Electrosurgical Excision Procedure (LEEP)? Retrieved January 06, 2021, from https://www.plannedparenthood.org/learn/cancer/cervical-cancer/whats-leep
15. Hong Kong Department of Health. (n.d.). Cervical Screening Programme. Retrieved January 06, 2021, from https://www.cervicalscreening.gov.hk/common_files/resource/files/eng.pdf