Abnormal smear test — what does it mean and what next?

An abnormal smear test means that changes were found in the cells taken from your cervix that need to be explained. In the great majority of cases this is not cancer, but a prompt for further checks: a repeat smear, an HPV test or a colposcopy. Which step is right for you is decided by your doctor, based on the exact result and your history.

How to read a smear test result

Smear results are reported using the Bethesda system. The terms you are most likely to see are:

• NILM — negative for intraepithelial lesion or malignancy. This is a normal result. It may include extra notes, for example about inflammation or micro-organisms — these are not cancer-related abnormalities.
• ASC-US — atypical squamous cells of undetermined significance. The most common and mildest abnormality; often the result of a passing HPV infection or inflammation.
• ASC-H — atypical cells where a high-grade change cannot be ruled out. Needs colposcopy.
• LSIL — low-grade squamous intraepithelial lesion. Usually reflects an active HPV infection, which in most cases clears on its own.
• HSIL — high-grade squamous intraepithelial lesion. A pre-cancerous change, not cancer, but it needs colposcopy, a biopsy and usually treatment.
• AGC — atypical glandular cells. A less common result that needs wider investigation, including colposcopy.

If your result says ASC-US or LSIL, there is more detail in the guide ASC-US and LSIL on a smear test — what they mean and what next?.

Is an abnormal smear dangerous

A smear is a screening test. Its job is to pick out cells that look different from usual — not to make a diagnosis. Most abnormal results relate to mild changes that go away on their own or only need monitoring.

Even an HSIL result means a pre-cancerous change that can be removed in a minor procedure before cancer develops. That is exactly why regular smear tests exist: to find changes at an early stage, before cancer develops.

What your doctor may advise

The next step depends on the type of abnormality, the HPV result (if one was done), your age and your previous results. The options include:

• A repeat smear after 6–12 months — for mild changes, especially in younger women.
• An HPV test — shows whether a high-risk virus is behind the changes. With an LBC smear it can be run on the same sample. For help interpreting the result, see Positive HPV test — what happens next?.
• Colposcopy — examining the cervix under magnification. Usually advised for ASC-H, HSIL and AGC, for LSIL in adult women, and for ASC-US with a positive HPV test.
• A biopsy — a small tissue sample taken during colposcopy if the doctor sees an area that needs histopathological assessment.
• Treating an infection — if the smear describes inflammation, the doctor may treat that first and then repeat the test.

Leave the interpretation and the choice of follow-up to your doctor. The same result in two women can lead to different recommendations.

What colposcopy involves and how to prepare

Colposcopy feels much like having a smear taken. The doctor inserts a speculum, wipes the cervix with a weak acetic acid solution and often with iodine solution, and then examines it through a colposcope — an instrument that stays outside the body. It takes 10–20 minutes and needs no anaesthetic. A biopsy, if needed, feels like a brief pinch; light spotting may follow for a few days.

So that the image is clear, for 2 days before the examination:

• avoid sexual intercourse,
• do not use tampons,
• do not use vaginal medicines (pessaries, creams, gels),
• do not douche.

Also:

• the examination is not done during a period — the best time is the first half of the cycle, once bleeding has stopped,
• you do not need to fast,
• bring your smear result, your HPV result (if you have one) and any earlier results,
• if you are pregnant, let us know when booking.

When not to delay

Book an appointment within the next few weeks if:

• your result says ASC-H, HSIL or AGC,
• you also have a positive HPV test, especially type 16 or 18,
• you have bleeding after sex, between periods or after the menopause,
• you have unusual discharge, pain in the lower abdomen or pain during sex,
• earlier abnormal results were never followed up.

How it works at Sonar Clinic

Abnormal smear results are discussed by Barbara Ossowska, MD — a doctor in gynaecology and obstetrics training. Within gynaecology and obstetrics she takes LBC smears and HPV tests and performs ultrasound scans.

A possible pathway:

1. Gynaecological consultation to discuss the result — 220 PLN.
2. Depending on what is advised: consultation + LBC smear — 350 PLN, consultation + LBC + HPV test (14 genotypes) — 520 PLN, or the same with ultrasound — 430 PLN and 600 PLN respectively.
3. Colposcopy — if the doctor considers it appropriate. Colposcopy will be available at Sonar Clinic soon; until then, the doctor will advise during the consultation where to have the examination.

Bring your smear result to the appointment. To book, call +48 880 018 703 or use online booking on the doctor’s profile. Sonar Clinic is at ul. Gubińska 8A, Wrocław. Consultations are held in Polish; please let us know when booking if you need language support.