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What an abnormal cervical smear result means

An abnormal or positive smear result does not mean you have cancer. It means you have some changes in your cervical cells that may eventually develop into cancer and these need to be looked at more closely. Abnormal changes (also called dysplasia or dyskaryosis) may be mild, moderate or severe. Most mild changes will go back to normal on their own, but if your changes are moderate or severe, you may need treatment.

Abnormal changes may also be called CIN1, CIN2 or CIN3. This is just another way of expressing mild, moderate and severe. CIN stands for cervical intra-epithelial neoplasia, which means ‘new changes in the outer layer of the cervix.’ The numbers 1, 2 and 3 refer to the depth of skin cells affected: CIN1 means the outer 1/3 of the cervix is affected, CIN2 means up to 2/3 of the skin thickness is affected and CIN3 means the full thickness of the cervical skin is affected.

The amount of CIN can really only be measured following a colposcopy and biopsy, but it usually matches the initial smear rating and may therefore be used to describe results before the extent of changes has been confirmed.

Mild changes (dyskariosis) or CIN1

If your smear result shows mild cell changes, you may be advised to have a repeat smear test in three to six months, and possibly another one a few months after that. The reason for waiting is that most mildly abnormal cells revert back to normal on their own without any treatment. Follow-up smears are to check if the cells have healed themselves. It is important that you go for your follow-up appointments, not only for peace of mind, but because any cells that have stayed the same, or continued to change, will need to be treated.

Some doctors may suggest a colposcopy (closer examination of the cervix) when mild changes are found, but most will want to wait and see if the cells go back to normal on their own. If you don’t want to wait and would like a colposcopy, talk to your doctor. She or he may be able to ease some of your concerns or may refer you for further investigations. If you are not offered a referral from your GP, you could contact a private clinic about having a colposcopy.

Questions to ask your doctor if your smear shows borderline or abnormal changes:

• What types of changes were found?
• What might have caused the changes?
• Should I have a colposcopy for a closer look at the cell changes? If yes, when and where?
• If not, when should I schedule my next smear?
• Did the smear show any signs of infection?
• Should I be tested for sexually transmitted infections? Should my partner(s) be tested?

Moderate and severe changes (dyskariosis) or CIN2 and CIN3

If your abnormal smear result is moderate or severe, you will be referred for colposcopy. This is a closer examination of your cervix (see colposcopy) and will help to determine whether or not you need treatment. Although it may take years for cell changes to become cancerous, prompt treatment will stop the process from going any further.

Carcinoma in situ

Some women with CIN3 may be told they have carcinoma in situ. Although this is not cancer, it is very close to it. Carcinoma in situ means that some of the cells look cancerous but are still within the skin layer. Only when the suspect cells break through the skin and spread to the tissue below is it considered to be cancer. If you have carcinoma in situ you should be treated as soon as possible.

Cervical glandular intra-epithelial neoplasia (CGIN)

Occasionally a smear test will detect changes in the glandular cells of the cervical canal. These cells are different from the skin cells found on the cervix itself (squamous cells) and once they begin to change, they are unlikely to go back to normal on their own. Changes in glandular cells tend to be more serious than changes in squamous cells and some studies suggest that women with borderline CGIN should be referred for further investigations (colposcopy) immediately. If left untreated, glandular cells may develop into a cancer called adenocarcinoma (glandular cancer).

How reliable are the results?

Statistics show that cervical screening saves lives and prevents most cases of cervical cancer from developing, but it is not always accurate. You may be told you have a normal smear result when you actually have cell changes that were not picked up by the laboratory (known as a false-negative).

You will probably never know whether or not this has happened to you, but hopefully any missed changes will either revert back to normal or will be picked up at your next smear. On the other hand, you may be told you have abnormal changes when you don’t (false-positive). In this case the colposcopy will reveal that your cells are normal and you will not be scheduled for treatment.

Pregnancy and abnormal smear

Colposcopy is safe during pregnancy but biopsy and treatment, if necessary, are usually postponed until after the baby is born. Abnormal cells will not affect your pregnancy, birth or the health of your baby. Most mild changes will go back to normal on their own and even moderate changes are unlikely to progress to cancer in nine months’ time. But if you have severe changes, it may be worrying to have to wait for treatment, particularly at what may be an emotionally-charged time in your life.

Some research suggests LLETZ and laser therapy may be safe in the first trimester of pregnancy if only a small amount of tissue needs to be removed. Cone biopsy, cryosurgery and cold coagulation should not be used at any time during a pregnancy.

Discuss your options and concerns with your doctor and/or nurse-midwife, and make sure you go to your follow-up appointments after the birth.

Causes, risk factors and prevention

The development of abnormal cells may be caused by a combination of factors, including:

HPV (human papilloma virus) – this sexually transmitted infection, also known as the wart virus, is the main cause of abnormal cells. If you have never been exposed to HPV, you will probably never have abnormal cell changes either.

But HPV is very common and most people have had it at some time in their life although they may not have known about it because there are often no symptoms. There are about 100 types of HPV but two types in particular are associated with cervical cell changes: HPV 16 and 18.

There is no treatment for HPV and while it may stay in your system for a few months to a few years, the body’s immune system eventually fights off the virus. By this time, however, it may have already caused changes in your cervical cells. Using a condom during sex may help to prevent HPV.

For more information on HPV and genital warts, see the Women’s Health online HPV leaflet.

Contraception – there is some evidence that women who use the pill may have an increased risk of developing abnormal cell changes, but the reason for this is unclear. It may be that women on the pill are less likely to use a condom and are therefore at greater risk of HPV infection.

Weak immune system – anything that weakens your immune system, from pregnancy to HIV, reduces your body’s ability to fight infections and may give abnormal cells a chance to grow.

Smoking – studies show that smoking increases a woman’s chance of developing abnormal cell changes. If you have a mildly abnormal or borderline smear result, giving up smoking, even just until your follow-up smear, may help your cells go back to normal.

DES – daughters of women who took the drug DES while they were pregnant may have an increased risk of developing CIN. The drug has been banned for use in pregnancy since the 1970s. If you are a DES daughter and have an abnormal smear result, tell your doctor that you have been exposed to DES. See Women's Health's online leaflet on DES for more information

Written by Tamara Beus and published in printed format (2003) by Women's Health

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