Why is my smear test result abnormal?

A Pap (or Papanicolau) smear test is a vital tool used by gynaecologists to monitor cervical health and prevent cancer. An abnormal test result can, understandably, cause patients concern. In this article, consultant gynaecologist, Dr Shahla Ahmed, expert in abnormal smear test results explains what they mean and what the next steps look like.

What is a Pap smear and what does an abnormal smear result mean?

A Pap smear collects cells from the cervix, which are then tested for Human Papilloma Virus (HPV) and cell abnormalities. Your GP or practice nurse usually performs it.

The United Kingdom’s cervical smear screening program started in 1988 and has reduced deaths from cervical cancer by almost four thousand women per year. Cervical smear tests detect the presence HPV. Abnormal changes in cells of the cervix are caused by HPV. These changes, if ignored, may develop into cervical cancer over a period of years. It usually takes ten years or more from acquiring HPV to the development of cervical cancer so having regular tests is important.

What are the most common causes of abnormal smear results?

Human Papilloma Virus is the cause of abnormal smear results. There are over 100 types of HPV and these affect different areas of the body. Certain HPV types affect the cervix and cause cell changes by altering their structure, resulting in abnormalities which are detected on cervical smear tests.

HPV is usually passed from person to person through sexual intercourse, but may also be found in women who have never had sex. As with many viruses, there is no specific treatment but HPV may be cleared by the body’s immune system. This means that a woman might acquire the virus and get rid of it herself, as her immune system fights it off. Most cases of HPV clear within one to two years, but it can persist for ten to fifteen years. It does not affect the uterus or ovaries and has no impact on periods or fertility.

Men may carry the virus but will not suffer from any symptoms. As a consequence, men carrying HPV may unknowingly pass on the virus during sex. Condoms do provide some, but not full protection. HPV is not considered a sexually transmitted infection and it should not prevent you from continuing your normal sex life.

What does it mean if you have two abnormal smear tests in a row?

If your first smear test result showed abnormalities in your cervical cells, it means that you were, at that time, carrying the HPV virus. A second abnormal test result could suggest that:

• you initially cleared the HPV, but that you have either been reinfected, or that the HPV has re-emerged
• the virus has never fully cleared since your first test and remains present

What are the next steps and how are abnormal smear tests treated?

A smear test result showing negative for abnormal cells but positive for HPV requires monitoring over time to see if the body clears the virus on its own. However, if after two years the virus has persisted and is still present¸ you will be referred for a further examination, known as a colposcopy. If your test result shows abnormal cells, you will also be referred for a colposcopy to take a closer look at the changes that may have occurred in the cells of your cervix.

A colposcopy is an examination of the cervix with a special instrument called a colposcope and is usually done by a gynaecologist. The colposcope, which is essentially a large microscope, is used to look at the cervix under magnification, in order to identify any changes. Just as during a smear test, you will be asked to lie on a special couch with your legs in stirrups, and the doctor will insert a speculum. Special stains will be applied to your cervix using cotton wool, and your cervix will be examined using the colposcope.

If everything appears normal, nothing further will be required. If the doctor sees an area of abnormality, a small tissue sample (biopsy) will be taken and sent to the laboratory for analysis. A decision about the next steps is made based on this result and your doctor will discuss this with you. Some types of low-level abnormalities are safe to be left untreated and monitored, as they may improve by themselves. Others may require treatment to remove the area of abnormal cells from the cervix, usually using a small wire loop. This is often done in a clinic, but some women may prefer to do this under general anaesthesia.

How common are abnormal smear tests? Why?

About one in twenty women will have an abnormal smear test result but only one in two thousand will be found to have cervical cancer. Abnormal cervical smears are common because most women (and men) carry HPV and unknowingly pass it on to their partners. HPV does not cause symptoms and there is no specific treatment for it, which is why it is so common.

If you wish to undertake a smear test or are concerned by abnormal test results, you can visit Dr Ahmed’s Top Doctors profile and reserve an appointment.