Abnormal Pap smears
A pap smear is a screen tool for detecting abnormal changes to the cells of the cervix.
The cervix is the lower part of the uterus where the gland cells of the uterus met the skin cells (squamous cells) of the vagina. This area where the two types of cells meet is called the Transformation Zone. Using a brush the doctor collects a sample of the cells and places them on a microscope slide. The slide is then examined in the pathology lab for any abnormal cells.
1 in 20 women will have a pap smear test that returns as abnormal.
Why should I have a pap smear?
A pap smear is the only way to detect precancerous cell changes of the cervix. Regular pap smears are important as the precancerous cells do not usually cause pain or any other symptoms.
If abnormal cells are found then treatment can be given to remove the abnormal cells. Without treatment the abnormal cells may develop into cancer cells.
Do I need a pap smear?
The recommendation is that all women who are sexually active have a pap smear every two years. Sometimes you will be advised to have a repeat pap smear in one year by your GP.
Why do the cells of the cervix change?
Cell changes on the cervix are caused by HPV (human papilloma virus). HPV is a very common virus. 80% of women will have the virus at some stage and 80% of these women will clear the infections without treatment in 12 months.
What does my abnormal pap smear result mean?
The abnormal cells are called either dysplasia or dysplastic cells, meaning “abnormal change in size and shape of the cells”. They can also be referred to as CIN (cervical intraepithelial neoplasia), meaning “new abnormal growth of cells within the tissue of the cervix”.
The changes are classified as possible low grade, low grade, possible high grade, high grade or cancer.
Possible low grade: often due to inflammation due to HPV infection or other microorganisms (bacterial, fungal, or viral).
Low grade: usually due to HPV infection or CIN I.
Possible high grade: usually means that the pathologist in the lab is uncertain of the findings but is suspicious that there may be a CIN 2 or CIN 3 present.
High grade: usually means that there is a high likelihood that there is a CIN 2 or 3 present.
Cancer: Cells seen on the pap smear are highly likely to be due to cancer of the cervix.
Glandular cell abnormalities: the pap smear is not a test for glandular cell abnormalities or for screening for cancer of the glandular cells.
Your doctor will advise you that you either need to repeat your pap smear in one year (as most low grade changes will resolve over this time frame) or refer you to a gynaecologist for further investigation (– see colposcopy).
Why did my GP refer me for a colposcopy?
It is dangerous to leave CIN 2 and CIN 3 untreated as they can spread deeper into the cervix and become cancer. Though not all CIN 2 and CIN 3 will progress to cancer it is not possible to predict which abnormalities will clear spontaneously and which ones will become invasive.
Colposcopy is the examination of the cervix (the opening of the womb) with a special microscope called a colposcope. It is performed in the gynaecologist’s office. It is very similar to the pap smear but some special stains are applied to the cervix to examine the abnormal cells to decide if treatment is needed.
What if I am pregnant?
A pap smear is safe in pregnancy and causes no harm to the pregnancy or baby. You should notify your GP or gynaecologist if you think you may be pregnant so that they can discuss the procedure with you.