In brief
- All women between 30 and 60 years old receive an invitation every 5 years to have a smear test performed by their general practitioner.
- First, your cervical smear will only be tested for HPV.
- HPV can cause changes in the cells of the cervix (the opening to your womb from your vagina), which can lead to cancer.
- If you don’t have HPV, your risk of developing cervical cancer is very low.
- Do you have HPV? Then the same cervical smear will also be tested for abnormal cells.
- Do you have HPV and abnormal cells? Then you will be referred to a gynaecologist.
- Do you have symptoms, such as blood loss other than during your menstrual period? Then you should make an appointment with your general practitioner.
Why take part in the cervical cancer screening programme?
If you take part in the cervical cancer screening programme, abnormalities can be detected early on and treated if necessary.
Treatment prevents an abnormality (like abnormal cells) from developing into cervical cancer.
What happens during the screening?
- First, your cervical smear is tested for HPV (human papillomavirus). A long-term infection with HPV gives a small chance of cervical cancer.
- Do you have HPV? Then your cervical smear will also be checked for abnormal cells.
- If you don’t have HPV, your risk of developing cervical cancer is very low. That is why your cervical smear will not be checked for abnormal cells.
Each year, about 700 women in the Netherlands get cervical cancer, and about 200 women die from it. Cervical cancer mainly affects women between 30 and 60 years old. That is why these women are invited to participate in the screening programme.
What is HPV?
HPV is the abbreviation of human papillomavirus. This is the virus that can cause cervical cancer.
There are more than 100 types of human papillomavirus. Of those 100 types, about 12 can cause cervical cancer. Your cervical smear will be tested for these 12 types.
HPV occurs frequently. Nearly everyone gets HPV at some point in their life.
- The virus is spread through sexual contact. Because HPV is highly contagious, even condoms do not always help.
- It is difficult to know how you became infected with the virus. It could have happened more than 10 years ago. You also won’t notice if you have HPV. Your body will usually clear the virus on its own within 2 years after infection.
- HPV can find its way into the cells of the cervix and cause abnormal changes in these cells. Abnormal cells usually are not cancer cells. The body often clears mildly to moderately abnormal cells on its own.
- Sometimes the body does not clear the virus or the abnormal cells. Cervical cancer can then develop very slowly. This can take up to 15 years.
Of every 100 women with HPV (1 of the 12 types), less than 1 woman will eventually develop cervical cancer.
When will you receive an invitation for the screening programme?
Are you between 30 and 60 years old? Then you will automatically receive an invitation every 5 years.
Are you 40 years or older, and did the test show that you do not to have HPV? Then your risk of developing cervical cancer in the next 10 years is very low. You will receive a new invitation in 10 years (instead of 5 years).
Have you received an invitation? Please make an appointment for the smear test at your general practitioner’s office. Make sure the smear test is done on a day when you’re not having your period.
Do you find it difficult to have a smear test done? For example, because you have had unpleasant sexual experiences, because you are still a virgin, or for another reason? Then you can request a self-test kit (in Dutch) You can do the test yourself at home. This way you can still participate in the cervical cancer screening programme.
How is a smear test done?
The smear test is usually performed by the doctor’s assistant. She will ask you a few questions first. Next, you undress from the waist down. The doctor’s assistant uses a special instrument called a speculum, which looks like a duckbill. She gently slides the speculum into your vagina. She then opens the speculum so she can see your cervix. She uses a small brush to take a small sample of mucus with cells from your cervix. She places the sample in a jar and sends it to the lab. The appointment takes about 10 minutes in total.
Your cervical smear will be examined further in the lab.
You will receive a letter with the results of your smear test within 4 weeks. Your general practitioner’s office will also receive the results.
Are you worried about having the smear test done? For example, because you have had unpleasant sexual experiences or because you are still a virgin? Tell your doctor or doctor’s assistant this before or when you have the test done. He or she will then take this into account.
On the website of the RIVM (National Institute for Public Health and the Environment) you can see what happens during a smear test under What happens when you have a cervical smear taken?
What do the results of my smear test mean?
You will receive a letter with the results of your smear test within 4 weeks. Your general practitioner’s office will also receive the results.
Have more serious abnormalities been found? Then usually your doctor will phone you first, before you receive the letter. Your doctor will explain what the results mean.
You can get the following results:
No HPV
91 out of 100 women get this result.
You do not have HPV. You do not have an increased risk of cervical cancer. Further testing is not necessary. Your cervical smear will not be examined for abnormal cells. You will be invited to repeat the smear test in 5 years. Are you between 40 and 50 years old and do you not have HPV? You will be invited to repeat the smear test in 10 years. This is safe because an HPV infection usually takes at least 15 years to develop into cervical cancer.
HPV and no abnormal cells
5 out of 100 women get this result.
No abnormal cells were found. This means that you do not have cervical cancer. You also do not have a preliminary stage of cervical cancer. We call this result PAP1.
HPV was found. Usually your body will clear this virus on its own. If this does not happen, the cells in your cervix could change. That is why you will be invited to repeat the smear test in 6 months. The cervical smear will be checked again to make sure the cells still look normal.
- For most women, the cells still look normal in the follow-up cervical smear. In that case, no further testing is necessary. You will receive another invitation for the screening programme in 5 years. Women between 40 and 50 years old will also receive a new invitation in 5 years.
- Sometimes abnormal cells are found in the follow-up cervical smear. Abnormal cells usually are not cancer cells. Your body often still clears these cells on its own. Just to be sure, you need to be examined by a gynaecologist (in Dutch).
HPV and abnormal cells
2 out of 100 women get this result.
These are results of PAP2 or higher (up to PAP5).
If you get this result, your general practitioner will always refer you to a gynaecologist (in Dutch). The gynaecologist checks whether the body can clear the abnormality on its own, or whether treatment is necessary.
Cells with abnormalities look different, but usually are not cancer cells yet. The body can often clear mildly to moderately abnormal cells on its own.
Sometimes it concerns a preliminary stage of cervical cancer. This is not cancer yet, and can usually be treated easily and effectively. This treatment can then prevent cervical cancer.
Cervical cancer (in Dutch) occurs even less often. Cervical cancer can often be treated more successfully if detected early.
Unclear
2 out of 100 women get this result. The cervical smear cannot be evaluated properly. For example, the sample does not contain any cervical cells, there is inflammation, or there is too much blood in the smear. In that case, you will need to repeat the smear test. Make an appointment for this with your general practitioner about 6 weeks after your first smear test.
For which symptoms should you contact your general practitioner?
Of course, it is still important to be examined if you have symptoms. Even if you do not have HPV. Or even if you have been vaccinated for HPV. And even if you recently had a smear test.
Examples of symptoms are:
- abnormal vaginal discharge (in Dutch);
- unexpected vaginal blood loss (in Dutch), red or brown in colour:
- after having sex
- if you are not having your period
- or more than 1 year after your last period (even if you only lose a little blood)
Make an appointment with your general practitioner doctor if you have symptoms like these. Your doctor will check whether further testing is necessary.
Costs of the smear test
The smear tests of the cervical screening programme are free of charge. The self-test kit is also free.
Do you have to see a gynaecologist because of an abnormal smear test result? Your health insurer covers gynaecological care. You do have to pay your policy excess (also called a deductible) first.
More information about the smear test
- You can call a regional information hotline. The telephone number can be found on your invitation.
- The RIVM website: cervical cancer screening programme (in Dutch). You can also find a video here, showing how a smear test is performed.