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Cervical Smears and Swabs

In This Article

Background Info

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What is a smear?

A smear is a screening test for the presence of dyskaryosis of cervical cells (CIN). It is not actually a screening test for cancer. The abnormal cells of CIN have the potential to become cancerous, but in many women, the dyskaryosis resolves itself, without intervention.
  • 1 in 10 smears will show dyskaryosis
  • The vast majority of these cases will spontaneously resolve
 
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Methods

  • Pap smear – older method, in which sample cells are transferred directly to slide for viewing
  • Liquid-based cytology – sample cells are placed in liquid solution for transport to the lab, whereby they are extracted for cytologic analysis.
 
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Indications for smear

  • Clinical suspicion - E.g. IMB, PMB
  • Screening
 
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Indications for swabs

  • Suspected infection
  • Elective: to test for subclinical infection
  • Before insertion of IUD / IUS
 
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The Screening Programme

  • NHS screening programme began in 1988
  • It is estimated to have reduced cervical cancer incidence by 90%
  • Estimated to save 4,500 lives per year
  • Now less than 1,00 deaths per year in the UK from cervical cancer
  • Offered to all women aged 25 – 65
  • Every three years between 25-50
  • Every 5 years between 50-65
  • Age 65+ - offered to those:
    • Who have not been screened since 50
    • Who have had recent abnormal smears
    • Used to be offered to all women aged 20-65 – but at age 20, the physiological changes seen in puberty may still be apparent, and thus there was a very high percentage of false positives.
  • What does it involve?
    • A smear test – usually performed at the GP surgery.
    • If this is abnormal, then the patient will be referred for colposcopy, at which time, treatment can be performed if necessary.
  • Attendance
    • Roughly 80% of those eligible attend for smear screening
    • Reminders – usually, if one appointment is missed, a second invitiation is sent, then if this is missed, another reminder probably won’t be sent, but whenever the patient attends to GP, it will be flagged that a smear has been missed.
 
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Results

Result
Comments
Action
Negative
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Inform the patient of the result. Invite any questions. Treat any ongoing infection
Inadequate sample
Usually the result of poor sampling technique, but could just be a difficult case
Repeat the sample as soon as possible. If three inadequate samples, the refer for colposcopy
Borderline
 
Borderline changes in endocervical cells
  • Refer for colposcopy
Borderline changes in squamous cells
  • Repeat screen within 6 months – most cases will have resolved, and smear will be normal at this stage
  • Compare past results – if there are >3 borderline changes within 10 years, Refer for colposcopy.
  • Three consecutive normal smears are required before patient can return to the normal screening programme
Mild dyskaryosis
 
Usual practice to refer for colposcopy after one abnormal smear, but acceptable to have two, six months apart before referral.
  • 60% of cases will ultimately resolve spontaneously by the time of the 2nd smear (within 6 months)
Moderate dyskaryosis
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