Abnormal smear results

Australia has one of the lowest rates of cervical cancer in the developed world thanks to implementation of excellent national screening and successful Human Papilloma Virus (HPV) vaccination programs. HPV has been shown to be the cause for 70-80% of cervical cancers and by trying to prevent initial infection and through early identification of abnormalities caused by HPV, we aim to significantly reduce the impact of cervix cancer on the community.

Since 2007, 12-13 year-old school students have been offered free vaccination against the major high-risk strains of HPV. There is also free access to vaccination, up to the age of 19, as part of the National Immunisation Program’s catch-up program.

Women are also encouraged to have a cervical screening test (CST), previously known as a Pap smear, between the ages of 25 and 74. Some of these tests will return results which are abnormal and this can cause a lot of anxiety about cervix cancer but it is important to know that CST results are not diagnostic and that rarely does it mean that cervical cancer is present. Consequently, further assessment with colposcopy by a specialist gynaecologist with experience in pre-cancerous changes of the cervix is necessary.

There are two parts to a CST which determine the need for further assessment:

1. Firstly, testing is used to identify the presence of high-risk HPV infection. There are many different types of HPV strains and about 20 have been identified as high-risk for causing pre-cancerous and cancerous changes to the cervix if it is not cleared by the body’s own immune system.
2. Secondly, the cells sampled on the smear test are looked at under the microscope and examined for abnormality. These can be normal, indeterminate or abnormal regardless of the HPV result. Abnormal cells can generally be seen during colposcopy.

The chances of identifying any abnormalities during colposcopy are based on the results obtained from the smear performed by your doctor. These results will provide the gynaecologist with a guide as to what to expect.

During colposcopy, I will examine you using a speculum, in a similar way to when your doctor collects a CST. The colposcope is a special microscope on a stand which does not touch you but allows me to examine your cervix, vagina and vulva in much greater detail. A solution is painted onto the cervix to highlight any abnormal areas. If abnormal cells are seen which may explain the results of your CST, a small tissue sample (biopsy) may be needed to confirm the diagnosis and to determine if you need any treatment.

If a biopsy is taken, you should avoid strenuous exercise for 24 hours. You can also reduce the chance of bleeding and infection by avoiding sex, use of tampons, swimming, spas and baths for 5 days.

Please note, it is important that you do not have your period at the time of your appointment. It would be best to reschedule your appointment should you think that this will be an issue.