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Abnormal smear

A cervical smear is designed to detect abnormalities of the cervix (and vagina). It is not designed to detect cancers of the womb or ovary. When smear results are reported back to the patient they can be any from the following list:

  • Normal
  • Borderline
  • Mild
  • Moderate
  • Severe
  • Cancerous
  • Inadequate
  • Ungradeable

The vast majority are, of course, normal. A small proportion ( 1 to 3%) are deemed inadequate due to various reasons. These may include not having enough cells of interest (eg after the menopause), or too much blood obscuring the cells of interest (eg if smear carried out during a menstrual period), or too many other irrelevant cells obscuring the picture (eg cervix infection causing too many inflammatory cells).

A precancerous result includes borderline, mild, moderate, severe or ungradeable. A borderline or mild result is deemed a "low grade" abnormality whereas a moderate and severe result is deemed a "high grade" abnormality. Some laboratories report an ungradeable category and this merely implies that some precancerous change has been noted on the smear but the degree is uncertain and hence could be anything from borderline to severe (or sometimes cancerous).

A "cancerous" smear result is very rare and is reported when there are features worse than severe to suggest the possibility of transition to cancer from precancer. These are referred urgently for colposcopy for further investigations.

What happens after an abnormal smear result?

Following an inadequate result, the smear is usually repeated after a few weeks. Occasionally the doctor may prescribe some hormone cream (if inadequate cells following menopause) or antibiotics (if suspecting cervix inflammation) prior to repeating the smear. After two consecutive inadequate smears a referral for colposcopy is arranged.

Following a low grade abnormality (borderline or mild) the smear is repeated after 6 months usually by the GP. If there is a persistent abnormality of any sort, a referral for colposcopy is arranged. With a high grade abnormality (moderate or severe), a referral for colposcopy is arranged as soon as the result is available.

In the Surrey region, the laboratory reporting the results often bypasses the GP and initiates a "direct referral" to the colposcopy clinic. Therefore, when a patient is notified of an abnormal result by the laboratory, it also simultaneously sends a letter to the hospital colposcopy clinic asking it to arrange an appointment for colposcopy. There is usually a wait of between 4 to 8 weeks.

Most private health insurances will cover colposcopy under their scheme. Therefore, if you wish to avoid the wait then a private referral is much quicker (usually within 1 week). The results of the colposcopy examination and any biopsies taken are also available more quickly after a private colposcopy. If you wish to pursue this route then contact your insurer to pre-authorise the private referral.

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