WHAT IS A CERVICAL SMEAR?

The cervical smear or Pap test is a relatively simple screening test first introduced by Dr George Papanicolau in the early 1940s.  It is designed to detect abnormal cells which might be pre-cancerous in the cervix (neck of the womb). 

WHO SHOULD HAVE A SMEAR TEST?

Theoretically, women become at risk of developing an abnormal smear test once they become sexually active.  For most women therefore it is sensible to start having smear tests in the early 20s and then to continue at regular intervals until the mid 60s when they can safely be discontinued providing that the results have always been negative.  There is some debate as to how frequently smear tests should be performed and this is often determined by an individual woman’s circumstances, but between one and three years is the usual recommendation. 

HOW IS IT PERFORMED?

The test is usually carried out as part of a routine gynaecological examination and takes one or two minutes to perform.  An instrument known as a speculum is passed into the vagina in order to expose the cervix and the cells of the cervix are sampled using a small soft plastic brush.  The brush is then immersed in liquid in a container and the cells shaken free.  The sample is then sent to the laboratory for testing and the result is usually available within a few days. 

HOW IS THE SMEAR TEST REPORTED?

The vast majority of smear tests will be reported as negative or no abnormal cells seen.  In such circumstances, normal follow up with repeat testing in 1-3 years is advised.  About one in 12 smears might be reported as showing abnormal or dysplastic cells.  These are often graded by laboratory pathologists as being mild, moderate or severely abnormal. The medical term for this problem is cervical intraepithelial neoplasia (CIN) and the grades CIN1, CIN2 and CIN3 equate to mild, moderate and severe changes. 

Some smear tests are reported as borderline which means that they are not good enough to be classed negative but not bad enough to be graded even mildly abnormal.  In such circumstances the usual recommendation is merely to repeat the smear test in six months when, in the majority of instances it has reverted to normal, spontaneously. 

WHAT IF THE SMEAR TEST RESULT IS ABNORMAL?

If the smear test shows abnormal cells, then the usual recommendation is that the woman should be referred for a procedure known as colposcopy. It is important to appreciate that the abnormality itself is microscopic, and that the cervix to the naked eye looks completely healthy. Therefore in order to locate the position and extent of the abnormal cells, the cervix needs to be inspected under magnification. This is colposcopy. The procedure takes a few minutes to perform and is no more uncomfortable than having a smear test, but the womans legs are placed in leg rests in order to allow the examination. Two stains are usually painted on the cervix which help to show up the abnormal cells and in some circumstances a small tissue sample or biopsy is taken.

HOW IS THE PROBLEM TREATED ?

Sometimes, if the problem is only mild, no treatment is necessary and a follow up examination and smear test is arranged in 6 months, when it is hoped that the minor abnormality will have healed spontaneously. With more significant abnormalities on the smear test and at colposcopy, treatment is required. This is usually quick , simple and very effective, and involves removing the area of “skin” on the cervix that contains the abnormal cells.

The method most commonly used is called LOOP DIATHERMY or LLETZ and involves an electric current passed through a small wire loop, which is then used to remove the small piece of abnormal tissue. In 85% - 90% of cases this can easily and painlessly performed under local anaesthetic in the outpatient clinic. The procedure takes a matter of minutes and the woman is able to leave the clinic immediately afterwards. With more extensive lesions, the gynaecologist might recommend that the treatment should be performed under general anaesthesia, and this will require admission to hospital for a few hours

Following the treatment there is no pain, but there is bleeding and discharge, much like the end of a period which might persist for 2-3 weeks as the cervix heals. During this time it is advisable to use pads not tampons and to avoid intercourse.

WHAT FOLLOW UP IS REQUIRED?

LOOP DIATHERMY or LLETZ treatment is very successful with a 95% cure rate. It is very important however to ensure that an individual woman is not in the 5% of cases where the problem persists or returns. Follow up patterns may vary, but it is usual to suggest that a check colposcopy and smear test are performed 4 months and 1 year after treatment. If these test results are negative, the woman is advised to have annual smear tests for the next 3 years.

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