What does an abnormal smear result mean?
It is understandable that you may get anxious if you receive a letter of referral to a colposcopy clinic because of abnormal smear test results.
The first thing to say is that the vast majority of women in your situation do not have cancer, but a condition with changes in the neck of the womb (cervix) that we call CIN (Pre-cancerous changes). Pre-cancerous changes of the cells of the cervix are those that have the potential to turn into cancer if left untreated for some time.
What does an inadequate smear mean?
An unreadable or inadequate smear does not mean that your smear is abnormal. This is an inconvenience but should not make you worry but be aware that you will be called for a repeat cervical cytology sample in three months. Waiting for this time before repeating the test reduces the risk of a further inadequate sample.
There may be many reasons for the inadequate smears. Difficulty in getting enough cells due to menopausal changes in cervix and complex problems in processing the cells, can be the possible reasons for the inadequate smears. Sometimes your doctor or practice nurse can advise a treatment that may make taking a further sample more effective, such as vaginal oestrogen cream if the inadequate smear is due to postmenopausal changes in the cervix or antibiotics if infection is present.
What are the different types of abnormal smear?
There are two groups of cells on the cervix – outer cells which are called ectocervical or squamous cells and inner cells also called glandular/ columnar or endocervical cells. Abnormalities can occur in both groups of cells but are much more common in the outer or squamous cells (called dyskaryosis on smear and CIN on a tissue biopsy).
Squamous cell abnormalities
Smears are graded with differing degrees of abnormality from a non- specific ‘borderline’ change to low grade and high grade changes called dyskaryosis (medical terminology used for abnormal cells.). Low grade smears will return to normal over a period of time in majority of women. High grade smears have a small chance of progression to cervical cancer, which may take more than 10 years.
Glandular cell abnormalities
Sometimes a smear result will come back as atypical glandular cells. It means abnormality is in the glandular or columnar cells of the cervix. In the event of having an abnormality in the glandular cells on the smear test (called Atypical Glandular cells on smear), you will be referred either directly by the Laboratory or your smear taker to the Colposcopy clinic.
What are the reasons for these abnormal cells?
Cervical cell abnormalities are caused by infection with a virus called HPV (Human Papilloma Virus). Majority of women and men get this infection at some point in their lives but clear the infection spontaneously. In a minority of these women, when the infection persists for long time, it can lead to these cervical cell changes.
I have an abnormal smear. What is the chance that I have cancer?
Whilst about 1 in 20 women will have a smear test result which is abnormal, only about 1 in 2000 will have cervical cancer. That means approximately 1% of women with any grade of abnormal smear will have a cancer. So statistically speaking the risk that you have already developed cervical cancer is very small even if your smear is abnormal.
However we realise that women worry about this possibility and this is where colposcopy is helpful. In majority of women, the colposcopy is very reassuring as it gives clearer picture of the situation. The colposcopist will be able to assess the size and the grade of abnormality as well as plan the further management.