With all the press at the moment concerning smear test rates hitting a 20-year low I felt compelled to write about my recent experience in the hope it will help.
So I’m definitely one of those women who puts off having a smear. When it’s bought up as something I need to do, I’ll already have a text book response which buys me some time before the subject comes up again, but the truth is if I didn’t have someone strap me down I probably would find any excuse not to do it. It just wasn’t a priority and with everything I have to deal with already I convinced myself if something was wrong it would somehow show up in one of the 100’s of blood tests I have to take on a regular basis.
However, one thing you may not know is when you are placed on the kidney transplant list there are a bunch of test you need to take and repeat to confirm you are still suitable to remain on the list. One of those tests is having a regular smear (every 3 years, which the national suggestion for my age group). I mean it makes sense, cervical screening checks for abnormalities in the cervix and after a transplant your put on a bunch of drugs that could make these abnormalities (if there are any) worse.
So under due protest (with myself) I had my smear, 1-2 years later than I should have. I had built the procedure up in my head so much that I thought it was going to be horrendously embarrassing but it wasn’t. I thought it was going to be painful, it was a little uncomfortable, but when compared to a lupus flare a smear is a walk in the park. It was all done in around 5 minutes, the same time it would take to get a blood test done.
My results came through in the post about two weeks later which unfortunately showed some minor changes since my last smear, and although the letter explained this does not mean it’s cancer I was devastated. They say people experience 5 stages of grief, well the same could be said about the days after receiving my results denial, anger, bargaining, depression and acceptance I experienced all of these emotions. I couldn’t believe how unlucky I was, lupus, kidney failure and now this! I jokingly said to my mum someone up there must be waging a bet on how much I can take.
After a few days of reflection and talking with very supportive friends and family it sank in that at this moment in time I didn’t not have a diagnosis and whatever this is (if anything) I’m thankful it’s been caught early. I realised by putting off having a smear I have been automatically putting myself at a disadvantage that should something be wrong it will not be caught early.
My appointment came quickly, the doctor was so nice and very patient with me as I was very nervous. He answered all my questions and reiterated that we are a long way off from this being something serious, but the best thing is to investigate any changes. He also mentioned lupus patients have a higher incidence of abnormal smears than others not having lupus, so my situation is not uncommon.
Even though the thought of having lupus affecting smear results is a little scary, In my eyes it makes it even more important to keep up to date with smears. I’m still under investigation and may will need more frequent smears which I find ironic coming from someone who tried to avoid them!
All of this has definitely taught me the importance of keeping up with regular smears. Being screened regularly means any abnormal changes in the cells of the cervix can be identified at an early stage and, if necessary, treated to stop cancer developing.
You can follow my lupus journey on Instagram: luppie_lu
It is widely recognised that abnormal smears are more common in women with SLE but that the risk of invasive cervical cancer is not greatly increased. The recommendation is that cervical smear tests should indeed be done according to national guidelines.
In 2017 the following study was published:
Cervical neoplasia in systemic lupus erythematosus: a nationwide study
The aim was to examine the risk of cervical neoplasia in women with SLE, overall and with respect to treatment, compared with women from the general population.
Based on 121 events of cervical neoplasia during 23 136 person-years among SLE patients, there was an increased risk of any cervical neoplasia compared with the general population [hazard ratio (HR) = 2.12 (95% CI: 1.65, 2.71)]. The risk of CIN 1 [HR = 2.33 (95% CI: 1.58, 3.44)], CIN 2-3 [HR = 1.95 (95% CI: 1.43, 2.65)], but not invasive cervical cancer [HR = 1.64 (95% CI: 0.54, 5.02)], was increased in women with SLE. The subcohort treated with other immunosuppressants was at highest risk of cervical neoplasia.
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