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1. Low grade abnormalities

I have a low grade abnormality on my Pap smear. What does this mean?

It is most likely that you have an infection with HPV. This is a viral infection, not cancer.

What is HPV?

This is a very common sexually transmitted virus. Four out of five people will have this infection at sometime in their lives and they may not even know about it.

When did I get this infection with HPV?

You could have caught HPV recently, or many months or years ago.

What will happen next?

The most likely thing is that your body will clear this infection and your Pap smear will return to normal.

Most women will clear HPV infection in one to two years

Why does it matter?

In a very small number of women the HPV infection is not cleared but stays in the cervix. In these women, there is a risk that abnormalities will develop that might lead to cancer over many years if they are not treated.

What should be done about this?

You will be monitored with a repeat Pap smear to make sure the infection clears.

If your repeat smear shows that the abnormality has stayed, you will be referred for colposcopy.

Most women with low grade abnormalities will not need a colposcopy.

What is a colposcopy?

A colposcopy is an examination undertaken by a specialist. It is similar to having a Pap smear as a speculum is used so the specialist can see the cervix. The specialist looks at the cervix carefully using a colposcope – an instrument that works like a microscope to magnify the cervix. The colposcope does not touch or enter the body. There is more information on colposcopy in Chapter 5.

Colposcopy will usually confirm the presence of a low grade abnormality that will not need treatment. You will continue to be monitored each year by your doctor until your Pap smear result returns to normal.

There is a small chance that the colposcopy will reveal a high grade abnormality that may require a biopsy and/or treatment. There is a summary of high grade abnormalities in the next section, and more information in Chapter 6.

2. High grade abnormalities

I have a high grade abnormality on my Pap smear. What does this mean?

It is most likely that you have an HPV infection which has persisted and caused an abnormality. This may lead to cancer over many years if left untreated.

For more information about HPV infection see Chapter 3.

This result does not mean that you have cancer, but it is important you have it checked.

What will happen next?

You will be referred for a colposcopy.

What is a colposcopy?

A colposcopy is an examination undertaken by a specialist. It is similar to having a Pap smear as a speculum is used so the specialist can see the cervix. The specialist looks at the cervix carefully using a colposcope – an instrument that works like a microscope to magnify the cervix. The colposcope does not touch or enter the body. There is more information about colposcopy in Chapter 5.

If the colposcopy confirms that you have a high grade abnormality you will then need a biopsy of the cervix. See Chapter 5 for more information.

If the colposcopy shows only a low grade abnormality, you will not usually require a biopsy.

Will I need treatment?

The results of the biopsy will be discussed with you and a decision will be made regarding the need for treatment. See Chapter 7 for information on treatment options.

3. Glandular abnormalities

I have a glandular abnormality on my Pap smear. What does this mean?

The glandular cells of the cervix are located mainly in the canal of the cervix. We know less about the early changes in these cells compared to changes in squamous cells, which cause the majority of abnormal Pap smear results. HPV may be related to some of these cell changes. There is more information on HPV in Chapter 3.

Glandular abnormalities are uncommon and in most women the changes are found to be unimportant.

However, in some women the changes are due to abnormalities that do need to be treated in order to prevent cancer. These cell changes need further assessment because a Pap smear is not as reliable in diagnosing the problem in glandular cells.

This result does not mean that you have cancer, but it is important you are investigated.

What will happen next?

You will be referred for a colposcopy.

What is a colposcopy?

This examination is undertaken by a specialist. It is similar to having a Pap smear. A speculum will be used so the specialist can see the cervix, which can then be carefully examined using a colposcope. This is a magnifying instrument that does not touch or enter the body. Colposcopy may reveal an abnormality that may require a biopsy and/or treatment. There is more information about colposcopy and biopsy in Chapter 5.

Will I need treatment?

The results of the colposcopy or the biopsy will be discussed with you. A decision will be made regarding the need for treatment or further surveillance. If your referral Pap smear suggested a high grade abnormality, then treatment will usually be advised.

Colposcopy may show no abnormality, but it is possible that the abnormal area is not visible, and treatment or further surveillance may be advised.

Cone biopsy is the usual treatment for glandular abnormalities. There is more information on treatment in Chapter 7.

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