A cervical screening, also known as the smear test, is used to detect any abnormal cells in a woman’s cervix. Cervical cells change over time, so it is important to regularly undergo screenings in order to monitor changes.
Most women who undergo a cervical screening will return with a normal result. However, around 1 in 20 smear test results will come back as abnormal. This does not mean cancer, but rather that there are changes in the cervical cells which should be investigated.
Abnormal cells found on the surface of a woman’s cervix are referred to as Cervical Intra-epithelial Neoplasia (CIN). CIN is divided into three classifications, used to describe how far these abnormal cells have developed in the surface layer of the cervix. The changes in cells can be graded as CIN 1, CIN 2 or CIN 3. The higher the grade, the greater surface area of the cervix is affected by abnormal cells.
The CIN 1 grade is used to describe mild dyskaryosis, which signifies mild changes to the cervical cells. This affects only one-third of the cervical surface area. These changes definitely do not signify cancer and in the majority of cases will not cause cancer in the future. CIN1 usually corresponds to infection with Human Papilloma Virus (HPV) and will often resolve by itself within six months. Usually, no treatment is required for an abnormal smear showing only mild dyskaryosis. However, a repeat smear test after six months is necessary to monitor changes.
A CIN 2 grade refers to two-thirds of the thickness of the surface layer of the cervix showing cell changes. It is used to describe moderate dyskaryosis and again, does not mean cancer. A colposcopy should be carried out when moderate dyskaryosis is detected and following this, treatment may be required to remove the abnormal cells.
CIN 3 refers to severe dyskaryosis and affects the full thickness of the cervix surface. Even with this result, it is unlikely that a woman already has cervical cancer. However, it is important to treat severe dyskaryosis as soon as the changes are detected. Treatment is used to remove the abnormal area so that these cells do not develop into cancer in the future.
High Grade Dyskaryosis
If you have recently undergone a routine cervical screening, then you may have received a letter stating that your smear was abnormal and that high grade dyskaryosis has been detected. High grade smears include moderate and severe pre-cancerous cell changes, which often require treatment.
Though this diagnosis means it is unlikely that you already have cancer, the abnormal smear test result indicates that if these changes were to be left untreated, they could develop into cancer in the future. It is therefore highly important that all women with severe dyskaryosis and most women with moderate dyskaryosis seek treatment.
Not all abnormal cells require immediate treatment. GPs may recommend a surveillance, or “watch and wait” approach for younger women whose abnormal smear has detected moderate dyskaryosis. This is because in these age groups, changes may regress back to normal without intervention.
An expert in colposcopy should assess every patient with high grade cervical changes to establish the true nature of the diagnosis. A colposcopy is a simple examination takes around 10-20 minutes and involves inspecting the vaginal and cervical tissues using a type of microscope which magnifies the cervix surface between 10 and 40 times its size. The colposcopy results can determine whether treatment to remove the cells is needed.
Treatment for High Grade Dyskaryosis
Treatment to remove abnormal cervical calls is recommended when there is a moderate to high chance of these cells developing into cancer if left untreated. There are several different treatments used to remove abnormal cells. With high grade dyskaryosis, the most commonly carried out treatment is Large Loop Excision of the Transformation Zone (LLETZ).