Cervical Cytology: Related Pages

At a Glance

Why Get Tested?

To screen for early abnormalities which, if left untreated, could lead to cervical cancer.

When to Get Tested?

In England, all woman between the ages of 25 and 64 are eligible for a free cervical screening test every three to five years, depending on age.
In Wales those between 20 and 64 are eligible for screening at 3 yearly intervals.
In Scotland those between 20 and 60 are eligible for screening 3 at yearly intervals.
In Northern Ireland those between 20 and 64 are eligible for screening at 5 yearly intervals.
In the Republic of Ireland those between 25 and 44 are eligible for screening at 3 yearly intervals and those between 45 and 60 at 5 yearly intervals.

Sample Required?

Cells from the cervix (neck of the womb)

The Test Sample

What is being tested?

A cervical cytology test is a test used to detect abnormal or potentially abnormal cells from the uterine cervix (neck of the womb).

How is the sample collected for testing?

The method consists of sampling cells from the cervix. A doctor or nurse inserts an instrument (a speculum) to open the woman's vagina. The sample is obtained using a brush. Most women consider the procedure to be only mildly uncomfortable although some have more discomfort, but it should not be painful. The specimen is put into a special liquid preservative. This cell suspension is processed onto a glass slide, stained, and examined in the laboratory.

You may be asked to refrain from sexual intercourse for 24-48 hours before the test, avoid using vaginal creams or foams in the 48 hours before the test and book the test appointment 10-14 days after the beginning of your last menstrual period.

NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

The Test

How is it used?

Your doctor or health provider performs a cervical cytology test to look for cervical cells that are abnormal or even potentially cancerous. The cell suspension is processed in the laboratory and placed on a glass slide, stained with a special dye, and viewed under a microscope by a cytologist or pathologist. Abnormal cells can be present without causing any noticeable symptoms. Some of those screened may require treatment whilst others may require further testing or need to be monitored over a period of time to allow them to resolve on their own.

^ Back to top

When is it requested?

In England a woman registered with a GP receives her first invitation at the age of 25. There are three-yearly examinations between 25 and 49, and five-yearly examinations between 50 and 65.

^ Back to top

What does the test result mean?

A "negative" smear means the cells obtained appear normal. In some instances (less than 3 in 100), the sample may be reported as "inadequate" for evaluation. This generally means there are insufficient cells for reliable assessment. A summary of other reported results follows.

Borderline changes: Cells present which may represent wart virus (HPV) infection or where there is uncertainty over their nature. The majority revert to normal without treatment.
Mild dyskaryosis: Low grade changes often associated with HPV and which commonly improve without treatment.
Moderate dyskaryosis: Abnormal cells present which may need treatment.
Severe dyskaryosis: Abnormal cells present reflecting the probable presence of high grade pre-cancer (CIN) which is likely to require treatment.
Severe dyskaryosis/?Invasive carcinoma: Abnormal cells present reflecting the probable presence of high grade pre-cancer (CIN) and cancer needs to be excluded.
?Glandular neoplasia: Abnormal glandular cells present which may arise from the cervix, the uterus (womb) lining or rarely the ovary.

^ Back to top

Is there anything else I should know?

Cervical cytology is used as a screening test in the well established national screening programmes. A small percentage of abnormalities in women may go undetected with a single test, which is why it is important to be screened regularly. The sample represents a only some of cells present on the cervix. Even for the most experienced nurse or doctor, sample collection can be occasionally insufficient and a repeat may be required (fewer than 3 in 100).

Cervical cytology, formerly the smear test, when performed routinely, has been a great help in the detection and treatment of cervical abnormalities known as Cervical Intraepithelial Neoplasia (CIN), which helps prevent cancer from developing. Early detection and treatment can prevent approximately 75% of cancers developing.

It is also important to realise that if you have any abnormal bleeding, for example, after sexual intercourse, between periods or after the menopause that you seek advice from your general practitioner about whether a gynaecological referral is needed. Cervical cytology is not appropriate in these circumstances.

^ Back to top

Common Questions

1. What are the risk factors for cervical cancer?

The most important risk factor for cervical cancer is infection with some strains of the human papilloma virus (HPV, which can sometimes be called wart virus infection). High risk strains of HPV are found in 99% of cervical cancers. HPV is a very common sexually transmitted virus which most people contract shortly after becoming sexually active. In 9 out of 10 women, the virus is cleared naturally by the body’s immune system within a year.

Tests are available to detect this infection but at present they are not part of the cervical screening programme. Trials are currently taking place in England to assess the usefulness of HPV testing.

A vaccine is also now available to prevent infection with the most common high risk types of HPV. In the UK, from Autumn 2008, the HPV vaccine is being offered to girls aged 12-13 years as part of a national vaccination programme. The vaccine will made available through most schools and for older teenage girls through their general practitioners . It is given in three doses over a period of six months and should ideally be given before a girl becomes sexually active. However, even if you have been vaccinated, it is important to continue to accept your invitation for screening.

Some risk factors such as the age at which sexual intercourse begins (the earlier, the higher the risk) and multiple sexual partners, contribute an increased risk of having the virus. Other factors are infrequent cervical screening, a history of abnormal cervical cytology or treatment for cervical abnormalities, using the oral contraceptive pill and cigarette smoking. Women whose immune systems are less active are also at increased risk and women who are HIV positive are recommended to be screened annually.

In most of these circumstances, with the exception of previous treatment for high grade cervical abnormalities, regular 3-5 yearly screening is sufficient protection from cervical cancer.

^ Back to top

2. Does an abnormal cervical smear always mean cancer?

A single "abnormal" test does not necessarily indicate that cancer is present. The tissues of the cervix undergo constant changes and repair. Treatment of abnormalities may be immediate, but for low grade disease, often while treatment may not be necessary immediately, the situation should be monitored closely. This may require a repeat testing at regular intervals until the situation is resolved.

^ Back to top

3. If I have cervical disease, what are my treatment options?

Progression from HPV infection through cervical abnormalities to cervical cancer is slow, and may take many years. It is because of this, that regular cervical screening offers the best opportunity to prevent cancer from developing by allowing the detection and removal of abnormal tissue. Regular tests may also detect the cancer early if it does develop.

Minimally invasive surgery of the cervix, also known as LLETZ, which can be carried out in an outpatients clinic to remove abnormal areas of the cervix or a very early stage cancer is the standard treatment. In more advanced cervical cancers, a hysterectomy (removal of the womb) may be performed. New surgical techniques are being developed to preserve fertility when cervical cancer affects young women. In some circumstances, where the cancer is more advanced, radiotherapy or chemotherapy may be required and, additional surgery may be needed.

^ Back to top

Ask a Laboratory Scientist

Article Sources

« Return to Related Pages

NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.