Pap (cervical) smear test

Reviewed by Dr Philip Owen, consultant obstetrician and gynaecologist

Why take a smear test?

The cervical smear test is designed to detect pre-cancerous changes in the cervix (neck of the womb). Pre-cancerous changes (properly called cervical intra-epithelial neoplasia, or CIN for short) are common in all age groups and cause no symptoms. This means that women will not be aware of CIN unless they have a smear test.

Are pre-cancerous changes (CIN) important?

There is always the potential that pre-cancerous changes might go on to become actual cancer of the cervix. It is also possible for pre-cancerous changes to go away by themselves. However, it is not possible for your doctor to predict which woman's pre-cancerous changes will go away untreated and which woman's pre-cancerous changes will go on to actual cancer.

It is not certain how long it takes for the abnormal cells to develop into cancer. If preventive measures are not taken cancer does develop in up to 50 per cent of cases, although this might take several years to happen.

How is a smear test carried out?

The smear test is taken in conjunction with a pelvic examination. A sample of surface cells is taken from the cervix with a small flat wooden spatula or a small brush. The specimen is placed on a small glass slide, fixed, stained and sent away to a laboratory to be examined under a microscope. The laboratory technician will then classify the smear test into either normal, borderline abnormal, mild, moderate or severely abnormal.

What happens if the smear is normal?

The woman is informed and it is recommended that the smear test is repeated in three years' time.

What happens if the smear is borderline or mildly abnormal?

The woman is informed and it is recommended that the smear test is repeated in 6 or 12 months time.

What happens if there is a moderate or severe abnormality?

The woman will be informed and invited to attend a colposcopy clinic for further investigation and treatment.

What is a colposcopy?

This is a procedure in which the gynaecologist examines the surface of the cervix using a magnifying instrument known as a colposcope. Although cell changes cannot be seen directly, the fine blood vessels under the cervix develop in a characteristic way during cell changes.

The gynaecologist will look out for such signs and in cases where cell changes have occurred, estimate how far they have grown and exactly how much they have changed.

Biopsies will be taken from the site on the cervix where the colposcopy has identified that cell changes have taken place.

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