What Does It Mean If My Smear Is Abnormal? 

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An abnormal Pap smear (cervical screening) test result means that abnormal changes in the cells covering your cervix (neck of your womb) were detected in your sample. These changes do not mean that you have cervical cancer as abnormal cells often go back to normal by themselves.  Rather, they indicate that you may have pre-cancerous cells in or around your cervix that require further investigation and/or treatment. Left untreated, these abnormal cells could develop into cancer in the future. 

The "Pap" in Pap smear stands for "Papanicolaou," named after Dr. George Papanicolaou, the Greek doctor who developed the test.

Most women who have a Pap smear will receive a normal result. However, around 1 in 20 smear test results will come back as abnormal. Abnormal results often indicate infection with Human Papilloma Virus (HPV). Around 20 strains of HPV are linked to cancer, with high-risk HPV strains 16 and 18 being responsible for around 70% of cervical cancer cases. 

Because the HPV virus can remain dormant for a very long time and produce no symptoms, many women are unaware that they have the virus. This highlights the importance of attending regular cervical screening appointments, where early diagnosis and treatment are possible.

Receiving Your Pap Smear Results

There are slight differences in the way cervical screening is done in England, Scotland, Wales, Northern Ireland and elsewhere in the world.

Interpreting Results from England, Scotland And Wales

If you are living in England, Scotland, or Wales, you will usually receive your results within 2 to 6 weeks.

In these UK countries, cervical screening looks for HPV (human papillomavirus). Your results will tell you whether you have HPV or not. If you have HPV, the results will also tell you if there are any abnormal changes in the cells that could lead to cancer. In the UK, your test results could include one of the following:

  • No HPV found - means that no high-risk HPV was observed. No further action is needed besides ongoing routine screenings. 
  • HPV was found with no cell changes - which means you have high-risk HPV, but no changes in your cervical cells were observed. You will usually be invited for cervical screening again in about a year to check that the HPV has gone.
  • HPV found with cell changes - means you have high-risk HPV and that cervical cell changes were observed. These changes are also called dyskaryosis. You should be invited to have a colposcopy and further tests. A colposcopy is a diagnostic procedure that a doctor uses to examine the cervix, vagina, and vulva more closely.

Interpreting Results from Northern Ireland And Elsewhere

In Northern Ireland and elsewhere in the world, they first test for changes in the cervical cells (cytology). If changes are found, they then test for high-risk HPV. Your results could include:

  • Normal - means that no abnormal cells were found on the sample.  
  • Abnormal - means abnormal cell changes (dyskaryosis) were found.

Abnormal results can be further described as borderline or mild cell changes (low grade) or moderate or severe cell changes (high grade). If you have low-grade changes, the laboratory will check for HPV. If no HPV is found in the sample, it is called HPV negative. In this situation, the cell changes are very likely to revert to normal or stay the same.

What Causes Abnormal Results?

An abnormal result means that cell changes were detected on your cervix.  Although an abnormal Pap test result does not mean cancer, it does require monitoring as HPV can lead to precancerous or cancerous changes in your cervical cells. Dyskaryosis (abnormal cervical cells) seldom causes any symptoms, such as pain, discharge, or bleeding. For this reason, all women should attend regular cervical screenings.

In more than 90% of cases, these abnormal changes on your cervix are caused by the human papillomavirus (HPV). Genital HPV is easily passed on through skin-on-skin contact as well as genital contact and oral sex.

Abnormal cells found on the surface of a woman’s cervix are graded into 3 categories based on the severity of observed abnormal cells. Mild (CIN 1), moderate (CIN 2) or severe (CIN 3) changes might be noted. These changes do not necessarily mean that you have cancer. Rather, they indicate that you may have pre-cancerous cells in or around your cervix that require further investigation and/or treatment.

What Happens Next?

Most people will not have HPV (an HPV-negative result) and are, therefore, not at risk of getting cervical cancer. They will be invited for screening again in 3 or 5 years (depending on their age).

If HPV was found in your sample, but no abnormal cells, you will be invited for screening in 1 year and again in 2 years if you still have HPV. If you still test positive for HPV after 3 years, you will normally need to have a colposcopy. If both HPV and abnormal cells were found in your sample, you should be offered a colposcopy.

A colposcopy examination is an important next step in determining if treatment is needed. If it becomes evident during a colposcopy examination that abnormal cells need to be removed, the doctor who is carrying out the colposcopy will often be able to remove them at the same time. However, if biopsy results are necessary to determine if cells need removal, a separate surgery date will be needed.

A cervical screening test will show if abnormal cells are present. It cannot, however, show how deeply the abnormal cells go into the cervix. To determine the grade of the dyskaryosis (abnormal cells), a biopsy from the abnormal areas of the cervix may be done. This tissue sample is looked at under a microscope to determine the grade of the dyskaryosis. This with this information, your doctor can decide on the most appropriate type of treatment. 

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