Abnormal Smears

Smear tests identify changes in cervical cells and help identify abnormal cells which can help prevent cervical cancer. It is quite normal for women to experience this at some stage in their life and it does not typically elude to anything serious. In fact, a test (or cervical screening) should be viewed as a preventative step as a mutation (however small) can be addressed before any serious complications arise. It’s why we recommend that all women over the age of 25 should book a cervical screen test.

Abnormal test result after cervical screening, should I be worried?

While is it understandable that you might be worried if you receive an abnormal smear result, it is important to bear in mind that 1 in 20 cervical screens come back with some form of abnormality. It is also natural to be concerned as to the severity of the cervical changes and what implications this may have on your health. However, an abnormal smear test result does not mean you have cancer. It simply means that there are changes to the cells which could potentially cause cancer in the future. This is why cervical screenings help to save lives!

Diagram of female reproductive system

Abnormalities in cervical cells are caused by an infection with the Human Papilloma Virus (HPV). This is otherwise known as the Wart Virus. It is estimated that as many as 75% of the reproductive-age population has an HPV infection with one or more types of genital HPV. The good news is that in the vast majority of cases (approximately 95%), the HPV virus causes no symptoms or health problems. Most women will fight the infection via their immune system, but for others, abnormal smears will require further tests and could indicate the progress of dyskaryosis

There are more than 100 different types of HPV and about 40 strains affect the genital areas and can be easily passed on through sexual contact. Several of these are linked to cervical cancer, which is why they are medically referred to as high-risk HPV strains. Of these, types 16 and 18 are the most common, causing 70% of cervical cancers.

Abnormal smear result grades

Squamous cells are the cells which cover the surface of the cervix. The cervical canal, or endocervix, is lined with glandular or columnar cells and produces mucus. The cervical tissue in which these types of cells meet is called the transformation zone and is where abnormal cells (atypical squamous cells) may form. During your cervical screening for cervical cancer, cell samples will be taken from the transformation zone.

An abnormal smear can be categorised as mild, moderate or severe dyskaryosis. A borderline grade is between moderate and mild. The abnormal cells which can be found on the surface area of the cervix are called Cervical Intra-epithelial Neoplasia (CIN) and there are three different Cervical Intraepithelial Neoplasia categories based on the amount of surface area affected by the abnormal cells.

  • CIN 1 means mild or low-grade dyskaryosis
  • CIN 2 means moderate dyskaryosis
  • CIN 3 means severe or high-grade dyskaryosis

If you have a low-grade dyskaryosis result (mild and borderline), then you will typically be advised to have an additional smear test or a colposcopy to quantify the initial results of the HPV testing and confirm the grade of abnormal cells. This is a small procedure, which feels very similar to having a smear test. The cervix is visualised using a speculum and it’s examined under magnification for evidence of low or high-grade changes. Two dyes are then applied to the cervix (acetic acid and iodine) to help highlight where the abnormal cells are present. If the changes are confirmed to be mild in nature, then a conservative approach will be recommended as it’s likely that the affected cells will go back to normal without the need for treatment.

High grade dyskaryosis

Where a smear test comes back with a high grade dyskaryosis result, the patient will be referred to a gynaecologist for a thorough examination through a colposcopy. This will establish the true extent of the affected cells. Those with high-grade dyskaryosis results often need treatment, which aims to remove the abnormal cervical cells.

Diagram showing the cervical transformation zone

It is important to recognise that cervical cancer can take up to a decade to develop, so a severe dyskaryosis result does not mean you have already developed it. However, knowing this does not mean that the results can be ignored.

Instead, you should always follow the advice of your doctor or gynaecologist and undergo regular screenings to monitor cervical changes, while promptly addressing any problems by attending follow-up requests and undergoing treatment where necessary to ensure that your cervix is healthy and unaffected by any pre-cancerous cells. Cervical screenings save lives!

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