In the UK, women over 25 are invited to attend cervical screening. Routinely, these come every 3 years up to the age of 45, then every 5 years up to the age of 65. A sample is collected from the neck of the womb (cervix) and this is tested for human papillomavirus numbers 16 and 18, or HPV 16 and 18, as these types of virus are known to cause cervical cancer. If the virus is present, the sample undergoes a second test to identify abnormal cells. It is common for women to feel anxious or self-conscious about undergoing this routine examination and cervical screening tests, particularly if the test has been performed painfully in the past. It is essential that the test is performed by an expert as this test should not be painful. It is reassuring to know that the majority of tests do not show any abnormalities and the likelihood of developing cervical cancer over the next three years is very low.
There are, however, some instances where these tests reveal abnormalities, either with the HPV testing alone or with the HPV testing and with abnormal changes in the cells that are located in the cervix. This is known as an “abnormal smear result”. This can cause a considerable amount of anxiety and worry.
In this situation, a colposcopy, a procedure in which the cervix is examined in more detail, is required. This test should be performed by an expert but is actually no more invasive than the original screening smear. The test can be performed in a clinic setting. In the majority of cases, no further action is required other than a repeat cervical screening test in the following year.
Less commonly, a precancerous lesion is identified. This can either be a low grade or a high-grade lesion. Low-grade changes do not require active treatment but follow-up is recommended with a further cervical screening test the following year, as many of these changes will spontaneously resolve without treatment. Only a small minority of low-grade lesions will progress to high-grade lesions, hence the need for follow-up after just 1 year.
If a high-grade lesion is identified, this can be further assessed by a small biopsy and then, if necessary, treated by removing the abnormal cells. These procedures are normally performed with a local anaesthetic, so the treatment should be painless.
A possible cause of abnormality
The most common cause of an abnormal smear is something that is referred to as Cervical Intraepithelial Neoplasia, or CIN. This describes a precancerous change to the cells based in the cervix and is something that could lead to the eventual development of cervical cancer if left untreated. The severity of Cervical Intraepithelial Neoplasia can vary a great deal depending on the stage of the condition. CIN1 is a minor or low-grade change, CIN2 and CIN3 are more severe or high-grade changes. In most instances, patients with CIN1 will not require any further medical intervention but it may be necessary for those with CIN2 and CIN3 to undergo treatment as CIN2 and CIN 3 are associated with an increased risk of developing cervical cancer.
Risk of cancer
It’s estimated that 1 in every 20 women who have cervical screening tests will have an abnormal test result and, in the UK, 3,152 cases of cervical cancer were diagnosed between 2015 and 2017. However, cervical screening, and more recently HPV vaccination, has led to a 25% reduction in the incidence of cervical cancer in the UK since the 1990s. The peak incidence of cervical cancer is in young women aged 30-34 years. It is therefore important to acknowledge that an abnormal smear is common, however, effective assessment and effective treatment should prevent the development of cervical cancer and also aim to maintain normal fertility for the overwhelming majority of women.
Advanced Gynaecology with Mr Francis Gardner
For over 25 years, Mr Francis Gardner has specialised in gynaecology and gynaecological cancer diagnosis and treatment. He is a member of the British Society for Colposcopy and Cervical Pathology (BSCCP). He is one of three founder members of the Egyptian Society for Colposcopy and Cervical Pathology. This is an organisation which is dedicated to improving the detection of precancerous cervical changes and the prevention of cervical cancer in Egypt. This organisation is endorsed by the BSCCP.
Mr Francis Gardner is an expert gynaecological cancer surgeon and a key member of a multidisciplinary team for gynaecological cancer. If in the rare situation a cancer is diagnosed, all investigations will be discussed with a multidisciplinary team and an evidence-based decision will be made to offer the best possible management of this condition. Any surgical treatment whether it is fertility sparing or radical complex surgery is offered by Mr Francis Gardner without the need for further referral.
To book in for a consultation with Mr Francis Gardner, or a “One Stop See and Treat”, get in touch today.
Cervical screening is based on the analysis of a sample taken from the neck of your womb (cervix) with a small brush most commonly in your GP practice. It is offered by the NHS to all women between the ages of 25 and 65 years. The initial screening takes place every three years from 25 years up to the age of 45 years and then this is reduced in frequency to every 5 years up to the age of 65 years. The NHS system is based on an analysis which has assessed both the risk benefit and cost effectiveness of more or frequent assessments. If you wish to be considered for screening outside the NHS system please contact Mr Gardner’s team, who will be happy to arrange a consultation and screening.
Cervical screening involves obtaining a small sample cells from the cervix with the aid of a vaginal speculum (to allow visualisation of the cervix) using a small brush. This test should take no more than a minute and should be pain-free. The sample is initially tested for High Risk human papillomavirus (HPV) (type 16 and 18), if one or both of these viruses is detected in the specimen it will then be tested looking for abnormal cells.
An abnormal smear result indicates that High Risk HPV has been detected or there is High risk HPV and abnormal cells. In most instances, this does not mean there is a cancer. However it will be recommended that you have a further assessment of the cervix called colposcopy.
A colposcopy is a thorough and detailed form of a cervical examination. This is conducted with the help of a speculum and an image-magnifying instrument (colposcope) which allows for a more detailed assessment of the cervix. Special fluids are placed on the cervix which highlights abnormal cells. In some clinics, DYSIS (digital colposcopy) is available at GenesisCare Havant and this can be used to enhance the assessment of abnormal lesions reducing over treatment of some lesions and facilitating safe conservative treatment. Please contact the bookings team at GenesisCare to book your DYSIS assessment.
No. There can be several explanations for an abnormal smear, one of the most common of these being the presence of Cervical Intraepithelial Neoplasia, or CIN. Of those women who display cervical abnormalities, only around 1 in 2000 of these are diagnosed with cervical cancer.