Cervical smear

Your doctor or health provider performs a cervical smear to look for cervical and/or vaginal cells that are cancerous or potentially pre-cancerous. The smeared cells or cell suspension is placed on a glass slide, stained with special dyes, and viewed under a microscope by a cytotologist or pathologist. The test can also be used to detect vaginal or uterine infections. This allows infections to be treated promptly, thus avoiding further discomfort or more serious complications.

In Australia:

1. Routine screening with cervical smears should be carried out every two years for women who have no symptoms or history suggestive of cervical pathology
2. All women who have ever been sexually active should start having cervical smears between the ages of 18 and 20 years, or one or two years after first having sexual intercourse, whichever is later. In some cases, it may be appropriate to start screening before 18 years of age
3. Cervical smears may cease at the age of 70 years for women who have had two normal cervical smears within the last five years. Women over 70 years who have never had a cervical smear, or who request a cervical smear, should be screened.

This policy applies to women with no symptoms and normal cervical/Pap smear results who should be screened every two years.

Women with abnormal smear results should be managed in accordance with the NHMRC Screening to Prevent Cervical Cancer: Guidelines for the Management of Asymptomatic Women with Screen Detected Abnormalities. Most of the costs may be claimed from Medicare

All States and Territories have cervical/Pap smear result registers that help doctors recall women for testing and keep track of any follow-up investigations. For information visit the National Cervical Screening Program.

A "negative" smear means the cells obtained appear normal. In some instances, the conventional cervical smear may be reported as "unsatisfactory" for evaluation. This may mean that cell collection was inadequate or that cells could not be clearly identified. A summary of other reported results follows.

• Unsatisfactory: inadequate sampling or other problem. Usually repeated in 6-12 weeks.
• Negative: non-cancerous cells, but smear may show infection, irratation or normal cell repair.
• Possible low-grade abnormality: minor changes in squamous cells or glandular cells for which the cause is undetermined. Usually repeated in 12 months.
• Low-grade abnormality: changes that may indicate infection with human papilloma virus (HPV). In most cases these will resolve without treatment.
• Possible high-grade abnormality: changes suspicious for, but not diagnostic of, a high-grade abnormality. Referral to a specialist is indicated.
• High-grade abnormality: abnormal cells that may result in cancer if left untreated. Referral to a specialist is indicated.
• Carcinoma: cancer is evident and requires immediate attention.

The cervical smear is generally used as a screening test. A small percentage of abnormalities in women may go undetected with a single smear, which is why it is important to have smears regularly. The most common errors are those made in collecting the sample. The smear represents a very small sample of cells. Even for the most experienced nurse or physician, sample collection can be occasionally inadequate and a repeat may be required.

The cervical smear, when performed routinely, has been a great help in the early detection of cervical cancer, which is treatable if caught at an early stage. Early detection and treatment can prevent 80 to 90 per cent of cancers developing. The smear is also used to monitor any abnormalities or unusual findings. In many cases, these findings are part of a body's repair process and often resolve themselves without any further treatment. If you douche, tub-bathe, or use vaginal creams 48 - 72 hours prior to the examination, your test results might be ‘unsatisfactory’. Other factors that may alter results include bleeding (menstruation), infection, drugs (such as digitalis and tetracycline), or having sexual relations within 24 hours prior to examination.

In these cases, a repeat smear may be necessary but does not necessarily mean there is a significant problem. In some instances, the use of the liquid-based techniques may eliminate some of the obscuring materials (blood and mucus) that may prevent a clear and uncluttered presentation of cervical cells. A second advantage is that the same sample may be used to perform additional testing for HPV if appropriate, and newer technologies involving automated scanning of smears can be applied.