Abnormal Smear (Pap test)
If you have received a letter telling you that your smear was abnormal, you will be understandably anxious and a bit worried. However, an abnormal smear almost always means that a minor problem (pre-cancerous change) has been detected and not anything serious (such as cervical cancer). It means that your smear test has done its job and this minor problem can now be dealt with. It is very common to have an abnormal smear (one in twelve smears are not normal), but it is extremely rare for this abnormality to be cancer.
What does it mean?
The smear abnormality can be mild, moderate or severe. Medical term used for describing an abnormal smear is dyskaryosis. Even when the smear shows severe dyskaryosis, it usually occurs 5-10 years before cervical cancer. Borderline grade is between normal and mild, so it means almost normal but not quite. Low grade smears (mild and borderline) will very often revert back to normal without any treatment; whereas, high grade smears (moderate and severe) often need to be treated. A colposcopy examination will often be recommended for any grade of abnormality.
What causes an abnormal smear?
Abnormal smears often represent a pre-cancerous abnormality on the cervix. These pre-cancerous abnormalities are caused by Human Papilloma Virus (HPV or Wart virus). This is a very common infection and 60-70% women (and men) get it at some stage in life. Most (95%) women will shake it off through their immunity, but in some women it may linger on and cause abnormal smears. More information on HPV can be found by clicking here.
What will happen now?
With low grade changes (mild dyskaryosis and borderline changes), either you will be advised to have a repeat smear or you may be referred to a gynaecologist for a special investigation called colposcopy. If the changes are confirmed to be mild on colposcopy, usually a conservative approach is followed as there is a good chance of spontaneous resolution. You must however make sure that you attend for follow-up as directed by your GP or gynaecologist. With high grade changes (moderate and severe dyskaryosis), you will be referred to a gynaecologist for colposcopy and possible treatment. If these changes are not treated, they carry a risk of progression to cancer over 5-10 years.
What does a colposcopy involve?
Colposcopy is a simple office procedure and as an experience is very similar to having a smear test done. Cervix is visualised using a speculum and it is examined under magnification for evidence of low/high grade changes. Two dyes are applied to the cervix (acetic acid and iodine) which highlight the abnormality if present. Colposcopy examination is carried out by a specialist gynaecologist who is accredited by the British Society of Colposcopy and Cervical Pathology (BSCCP). A nurse will also be present and you will be given an option to see your cervix on the screen.
What does the treatment involve?
The commonest form of treatment is LLETZ (Large Loop Excision of Transformation Zone). It is also known as LEEP (Loop Electrosurgical Excision Procedure, an American term). This is commonly carried out as an office procedure under local anaesthesia. After numbing the cervix with local anaesthetic, a wire loop is used to remove the abnormal cells. It is a quick and easy procedure and there is some discomfort, but no sharp pain.