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An abnormal smear test suggests that possibly some of the cells on the skin of the cervix may be growing faster than normal. The smear test is just a screening test, so if the smear is abnormal, the next step is to investigate further.

What is an abnormal smear test?

If your smear test has come back abnormal, it suggests that some of the cells on the skin of the cervix are growing faster than they should do. We know that some of these areas can go on to become cancers if left without treatment for months and years. However, many of the abnormalities will go away by themselves without treatment. The next step with an abnormal smear is to have a colposcopy.

Does an abnormal smear mean I have a cancer?

No. An abnormal smear reflects changes, just in the skin of the cervix and so are not cancer. If the changes are ignored over many years they may become a cancer, but when they are first detected by a smear, they are almost always confined to the skin only.

Because these changes involve just the skin of the cervix, they are not cancer. They can change into cancer if left for a number of years but often, these abnormalities will go back to normal without treatment.

How is an abnormal smear graded?

Abnormal smears are graded as borderline, mild, moderate or severe dyskaryosis depending upon how abnormal the cells appear. Even severe abnormalities only suggest changes that might become a cancer if left for a number of years. None of these findings suggest the presence of a cancer. The smear test is used as a screening test so the grade of abnormality is assessed better at colposcopy.


What is dyskaryosis?

Dyskaryosis is the term used to describe the abnormalities seen within cells in a smear. This is a technical term describing the abnormality shown by these cells when seen individually in a smear test.

These abnormal cells have a large nucleus which is often irregular in shape and appears more darkly staining than in normal cells. There may be multiple nuclei and their texture may appear irregular in density.


What is a borderline smear?
Smears are reported as borderline if the changes seen in the cells are not as much as mild abnormalities, but the cells are still not completely normal. This result represents a very low grade abnormality. The full term is often borderline nuclear atypia. A high grade abnormality is found in about 5% of women with borderline smears, and so it is important to investigate a borderline smear at colposcopy.

A borderline smear may be also investigated by performing an HPV test often on the same sample. A positive HPV result increases the chance of finding a significant abnormality on the cervix. If the sample shows no evidence of high risk HPV types, the risk of a significant abnormality is reduced.


What does severe dyskaryosis mean?

A smear test showing severe dyskaryosis suggests that the changes in the skin of the cervix might be high grade. High grade changes, often called CIN 3, have a greater chance of becoming a cancer if left, but this occurs at a slow rate. The risk of progression of a high grade abnormality is under 2% per year.  A colposcopy and biopsy is important to identify the abnormality in the cervix.

If a high grade abnormality is identified you are likely to be offered treatment to remove the abnormal skin.

Sometimes the smear test is wrong, and no abnormality is detected at all. This is called a false positive result. In this case no treatment will be necessary.


What does mild dyskaryosis mean?

A smear test showing mild dyskaryosis suggests that a low grade change is present in the cells on the skin of the cervix. Often these low grade changes called, CIN 1, will resolve without treatment. Sometimes, colposcopy will not reveal a significant abnormality at all.

In one woman in ten, a high grade abnormality will be identified, even though the smear suggests only a mild abnormality. These women will usually be offered treatment.


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