Abnormal Smear

On this page :- The Smear Test, Abnormal Smear test result, Colposcopy

THE SMEAR TEST

What is a smear test?

A smear test is taken to check for changes in the cells of your cervix.

The cervix is the lower part of the uterus that opens into the vagina.

Developed in the 1940s by Dr. George Papanicolaou, this test (sometimes called a Pap smear) can help to detect cervical cancer at an early stage. Around 1,500 women in the UK die from cervical cancer every year. The smear test is credited with saving tens of thousands of women’s lives and decreasing deaths from cervical cancer by more than 70%. The smear test can also spot infections which may need treating.

Who needs it?

Every woman should have a smear test.

All women between the ages of 20 and 64 are eligible for a free cervical smear test every 3 – 5 years according to the local health authority (Reference:NHS Cervical Screening Programme).

If you have any doubts about whether you need to be tested, consult your doctor.

When should I have it?

If you are eligible for a smear test and have not had one within the last 3 – 5 years, arrange to have one as soon as possible. Your smear test needs to be taken at least 5 days after the end of a period (if you’re still having periods).

Your doctor may send you a reminder when your test is due, so do let the Practice know if you change your address.

How do I prepare for a smear?

You should avoid using vaginal creams, having intercourse, or applying a lubricant jelly 24 hours before the test because it could cause inaccurate test results. You should tell your doctor if you have had a prior abnormal smear, if you think you may be pregnant, and if you are taking any medications or oral contraceptives.

What happens during the procedure?

A smear only takes a few minutes

You will be asked to remove your pants and to lie down on a couch, on your back or side, with your knees bent and legs apart.

A device called a speculum is gently inserted into your vagina and opened slightly so that the cervix (neck of the womb) can be seen. Then a spatula will be rubbed against the cervix to take a sample of some of the cells.

The sample is then spread onto a microscope slide and sent to a laboratory for analysis.

There are no risks involved in the test. However, you may experience some discomfort and a feeling of pressure during the procedure. A small amount of bleeding may occur after the test.

What happens after the procedure?

You may be sent your results or you may have to ask for them. Either way, it will take a number of weeks.

If the cells appear normal, no treatment is necessary. If an infection is present, treatment is prescribed. If the cells appear abnormal, more tests may be necessary. I will write to you with the results when available.

What does it mean if I’m called back?

Only very rarely does it mean that you have cancer. It might simply mean that your sample didn’t show up clearly, for example not enough cells may have been collected, and that another smear is needed. This is called an unsatisfactory result.

On the other hand, your result could point to some slight changes in the cells of the cervix. If abnormal changes, known as dyskaryosis, are detected, you will have what is called an abnormal result.

What happens if I get an abnormal result?

Your doctor will explain what needs to be done, for example, you may be asked to come back for more smear tests. Often the cells return to normal by themselves, but if the repeat smear test still shows abnormal cells, you may be asked to go to a hospital for a closer examination. Treatment, if needed, is virtually 100% effective. It is a minor procedure, usually done on an out-patient basis.

ABNORMAL SMEAR TEST RESULT

What does your Abnormal Smear test result mean?

The cervical smear test is designed to pick up minor changes before any problems develop and almost certainly that is what the test has done for you.

An abnormal result is not unusual: about one in ten smears is found to be abnormal.

It is important to remember that it is extremely rare for these abnormalities to be cancer. Nearly all abnormal smears show no more than small changes in the cells on the cervix (the neck of the womb).

What does my result mean?

An abnormal result usually means that small changes have been found in the cells on the cervix. The names given to these small changes are borderline changes or mild dyskaryosis.

In many cases these changes return to normal by themselves. Sometimes the changes are persistent and may become worse and could lead to cancer in the future. In such cases further examination and treatment is needed. Treatment is simple and usually very successful.

Fortunately, it usually takes many years for cancer of the cervix to develop. So it is rare, especially in women who have regular smears, for an abnormal result to show that cancer has already developed.

What do I do?

For many women their abnormal result will show borderline changes or mild dyskaryosis.

The changes are not cancer and in most cases do not lead to cancer in the future.

It is safe to give the changes a chance to return to normal by themselves without having immediate treatment.

If you have either of these results, your doctor will ask you to return for another smear test – a repeat smear. Your doctor will advise you when this is needed.

If the repeat smear is normal, you will be asked to have at least one more smear test in six to twelve months time to be sure that the cells are still healthy. If they are healthy you will then go back to receiving routine invitations as before.

If your repeat smear still shows borderline changes or mild dyskaryosis, you may be referred to a clinic for a further examination called colposcopy.

For some women their result will show moderate or severe dyskaryosis.

It is unlikely that this is cancer. However, these changes are less likely to return to normal by themselves and usually need treatment.

To decide whether you need treatment, a further examination – called colposcopy – is carried out to investigate the cervix in detail.

It is important that these changes are checked now, in case they become more serious in the future.

What is colposcopy?

This is a simple examination at a colposcopy clinic that allows the doctor to decide if you need treatment.

An instrument called a colposcope is used – it is just a magnifying glass which lets the doctor look more closely at the changes on your cervix. It does not go inside you, but some women may find the examination a bit uncomfortable.

If you need colposcopy make sure you read Colposcopy Information for Women.

What about treatment?

If you need treatment following colposcopy you will usually be treated as an outpatient and there should be no need for you to stay in hospital overnight. Treatment is usually very successful.

What follow-up will I need?

After treatment you will need regular check ups, which may include repeat smears, to make sure that the cervix is healthy again.

What about sex?

Sex does not make the abnormality worse and you cannot pass on changes or abnormal cells.

If you have treatment you may need to avoid sex a while. Your doctor or nurse will advise you.

Otherwise enjoy sex as usual, but you should use an effective contraceptive. It is important not to get pregnant until your abnormality is dealt with, as the hormones produced during pregnancy make treatment more difficult.

What causes an abnormal result?

The exact cause of changes in the cells or the cervix is still unknown. However, these changes are often associated with a virus which can be transmitted by sexual intercourse.

The human papilloma virus (HPV) is a very common infection of the cervix which is generally sexually transmitted. Many women catch the virus at some time. In most cases it clears naturally without the woman knowing it is there. Some forms of the virus can cause genital warts. Other types can cause cervical abnormalities which clear up when the virus has gone. In some women, however, the virus remains present for a number of years and cervical abnormalities will, in a few of these women develop into cancer if left untreated.

Further information

If you have any further questions regarding your condition or if you feel worried at all, do not hesitate to phone or make an appointment with your doctor, who will be happy to talk to you.

SOME REASSURING FACTS

It is not unusual to have an abnormal
smear: about one in ten smears
is abnormal.

Nearly all abnormal smears show no
more than small changes in the cells
on the cervix.

Treatment, if needed is simple
and usually very successful. You will
usually be treated as an outpatient. Once
healing is completed, you should not be
physically affected in any way.

COLPOSCOPY

Why am I going for colposcopy?

If the result of your smear test shows that abnormal cells are present your doctor may refer you to a specialist clinic for a further test. This is not unusual: about one in ten smears is abnormal. This may involve a test called colposcopy which is generally done in a hospital outpatient clinic.

What is colposcopy?

This is a simple examination that allows the doctor to decide if you need treatment.

An instrument called a colposcope is used - it is just a magnifying glass which lets the doctor look more closely at the changes on your cervix (neck of the womb). It does not go inside you, but some women may find the examination a bit uncomfortable – if you are having treatment as well then it can be performed under an anaesthetic

Is there anything I can do before the examination?

Some doctors and nurses prefer not to do colposcopy examination when you have your period, please ring your local clinic to check and to make another appointment if necessary.

What happens at the colposcopy clinic?

On arrival at the colposcopy clinic you will be asked a few questions, as accurate records are essential for treatment. It is particularly helpful if you can remember the date of the first day of your last period before going to the colposcopy clinic.

What happens during the examination?

For your own comfort it is helpful if you wear a loosely fitting skirt rather than trousers. The actual examination is similar to having a smear test except that a clear solution is applied to the cervix to make the abnormal areas show up more clearly. This is not painful. The doctor will look through the colposcope to examine the surface of the cervix in more detail. A small sample (biopsy) of tissue may then be taken from the cervix for examination in the laboratory. You may feel a slight twinge while the biopsy is being taken.

Usually colposcopy examinations only take a short time. After the examination you should feel well enough to continue with your usual routine. Treatment may be discussed at the first colposcopy visit but in some cases a second appointment is given so that the results of the biopsy can be explained and treatment arranged. However, in some clinics treatment may be carried out at this initial visit.

What will the examination show?

Colposcopy shows the type and extent of the abnormal area on the cervix. The results of the cervical smear, colposcopy and biopsy, if taken, will show if you need treatment and, if so, what sort.

What happens after the examination?

After you have dressed, the doctor may be able to tell you the results and what treatment, if any, is needed. However, if you have had a biopsy, it will take a few weeks before you get the result of this.

If you have had a biopsy, you may have a light bloodstained discharge for a few days following the procedure. This is nothing to worry about and it should soon disappear. It is advisable to avoid using tampons until the discharge clears up.

What if I need treatment?

Sometimes the abnormal cells return to normal without any treatment at all. If your doctor decides not to treat the minor changes, regular smears will be taken to ensure that further changes have not taken place.

Some abnormalities can be treated in the colposcopy clinic but some may require admission to hospital.

Will I need to have check ups?

Treatment is usually very successful. Regular follow-up smears are advised to detect any remaining abnormality or recurrence.

Treatment should have little or no effect on your future fertility, nor on your risk of having a miscarriage.

Some Points to Remember.

• If you think you may be pregnant, you should still attend the clinic appointment, but tell the doctor when you arrive.
  
• Do ask questions. It is much better to spend a little time then, than to worry later.
  
• If you have treatment you may need to avoid sex for a while. Your doctors or nurse will advise you.
  
• After the colposcopy you will be able to carry on with your normal activities.
  
• If you have had any treatment carried out it is advisable to take things easy for the rest of the day.

Further information

If you have any further questions regarding your condition or treatment, do not hesitate to phone the clinic or your doctor. They will be happy to help you.

There are very many women waiting for colposcopy, and it is very important that you let the clinic know if you cannot keep your appointment, so that clinic time is not wasted.

Please be sure to tell your doctors if you change your address.

Some reassuring facts

• It is not unusual to have an abnormal smear: about one smear in ten is abnormal.
  
• Nearly all abnormal smears show no more than small changes in the cells on the cervix.
  
• Treatment, if needed, is simple and usually very successful. You will usually be treated as an outpatient. Once healing is completed you should not be physically affected in any way.

	BSCCP - British Society for Colposcopy and Cervical Pathology BSCCP - Information for women