What do 'abnormal cells' mean after a smear test? Your questions, answered by the experts

·6-min read
Photo credit: Keith Brofsky - Getty Images
Photo credit: Keith Brofsky - Getty Images

A smear test itself is a standard procedure. All women aged 25-49 in England, Wales and Northern Ireland are invited for a cervical screening every three years (while in Scotland it's every five years for 25-and-overs.) But if results come back showing abnormal cells on the cervix, things can quickly go from 'routine' to 'worrying'.

But what does 'abnormal cells on the cervix' even mean? And what on earth is a colposcopy, if you're invited for one?

The first thing to note is that receiving an 'abnormal' cervical screening result does not mean immediate cause for concern. "An abnormal cervical screening result doesn’t always mean that your cells have changed," says Eluned Hughes, Health Information Manager at Jo's Cervical Cancer Trust. "It can mean that you have HPV (human papillomavirus), an extremely common virus that almost everyone will get at some point in their life."

In the event that there are some changes to your cells – abnormal cells are sometimes referred to as 'precancerous cells' – GP and Medical Advisor at Medexpress, Dr Clare Morrison, reassures that this doesn't mean that you have cancer. "It simply means that there are some abnormalities in the cells, which may increase the risk of developing cervical cancer in the future, if left untreated," she says, adding: "This only happens occasionally, and even then it usually takes several years to develop."

It's actually quite common to detect abnormal cervical cells in a smear test; around one in 20 women will be found to have them. In contrast, just one in 2000 women will have cervical cancer. So that should put it in perspective.

Smear test abnormal cells

Following an abnormal smear result, you'll be given guidance as to what to do next. You'll be told you need one of the following:

  • No further treatment: This will only be the case if you live in Northern Ireland, where a test called cytology is used instead of HPV primary screening for smear tests. This instruction means you have been found to have abnormal cells with low-grade changes, but no HPV (human papillomavirus) was found (more on that below.) 'No further treatment' means you will be required to have your next cervical screening test in 3 years, like everyone else aged between 25-49 in Northern Ireland.

  • Another cervical screening test in 1 year: This will be the case if you don't have cell changes, but you are found to have HPV.

  • Another cervical screening test in 3 years: This will be the case if you are not found to have HPV, and you are aged between 25-49 and live in England or Wales.

  • Another cervical screening test in 5 years: This will be the case if you are not found to have HPV, and you are aged between 25 or over and live in Scotland.

  • A colposcopy: This will be the case if you have abnormal cells with high-grade changes, or if you are found to be HPV positive and you have cell changes (low or high grade).

What is HPV?

"HPV is a very common virus which is the cause of almost every case of cervical cancer," explains says Eluned Hughes, adding that 8 in 10 adults will get HPV throughout their lives. "Most people clear it from their body within a couple of years, but if not, it can cause the cells in the cervix to change." The health expert explains that England, Scotland and Wales now test for HPV first as part of cervical screening (while Northern Ireland will move to this model in the future). "If you have HPV and your cells do look abnormal, you’ll be invited to colposcopy. If you have 3 smear test results that show HPV without abnormal cells, you will still be invited to colposcopy for a closer look," notes Eluned.

If you're asked to come for a colposcopy, there's no need to worry. Here's everything you need to know about the procedure:

What is a colposcopy?

"Colposcopy is a close examination undertaken at a Colposcopy clinic, to analyse and treat women who have had an abnormal cervical smear," Dr Clare tells Cosmopolitan.

What happens during a colposcopy?

"First, the gynaecologist will talk to you about the reason you are there, and what will happen. Then you will lie on the couch, and the Gynaecologist will insert a special speculum or 'colposcope' into the vagina.

"They will use a microscope to look closely at the cervix. They may spray a liquid, such as dilute acetic acid, onto the cervix, so abnormalities show up better," the doctor explains.

Photo credit: Anchiy - Getty Images
Photo credit: Anchiy - Getty Images

"If necessary they will remove some tissue. This may be several small pieces from the cervix, known as 'punch biopsies', to analyse the problem further. Alternatively they may remove all the surface tissue in the 'transformation zone' (the area of cervix where abnormalities tend to occur). This is called a 'large loop excision of the transformation zone' or 'LLETZ', and is done using an electrified wire loop (diathermy)," notes Dr Clare.

The reason for any removal of tissues is to get rid of any cells that might pose a risk of cervical cancer in years to come if they are not taken away.

Does a colposcopy hurt?

"It shouldn't be painful. If necessary, local anaesthetic may be administered before a biopsy or LLETZ, to minimise any discomfort."

Are there any side effects of a colposcopy?

"Afterwards you will likely experience a little vaginal spotting for a few days," explains the doctor. "The body heals itself quickly, the abnormal tissue being replaced by healthy cells within 4 to 6 weeks."

Photo credit: Getty Images
Photo credit: Getty Images

How long will it take to get colposcopy results?

"It takes about 4 to 8 weeks to get biopsy results from the colposcopy clinic," says the doctor. "If the biopsy report shows that the risk of developing cancer is low, it will only be necessary to have another cervical smear in 12 months-time.

"If the results indicate higher risk, you will need to return to the colposcopy clinic to have the affected tissue removed, most commonly by LLETZ," she adds."Rarely the results show that a woman actually has cervical cancer. In this case she would be fast-tracked to a team of specialists for urgent treatment."

Dr Clare Morrison is a GP and Medical Advisor at Medexpress. Eluned Hughes is Health Information Manager at Jo's Cervical Cancer Trust. For more information on abnormal cells after a smear test, head here.

This article is not intended to be a substitute for professional medical advice or diagnosis. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

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