What does it mean to get an abnormal smear test result?

220,000 people with a cervix are told they have abnormal cells every year.
Abnormal Smear Test Result What It Means And What To Do
Anna Iamanova

Cervical screenings are vital in preventing and treating cervical cancer, but receiving an abnormal smear test result can be concerning and confusing, and are one of the reasons why we're seeing a worrying decrease in people showing up for their smear test. 

Research by Jo’s Cervical Cancer Trust for Cervical Cancer Awareness Week this week (17-23 January) found that around 220,000 women are diagnosed every year following cervical screening, however over a quarter (26%) of those surveyed said they felt ashamed when diagnosed. 

The lack of information around what abnormal cells really mean is a huge issue. More than half (51%) of women surveyed said they knew nothing about cell changes prior to their diagnosis.

Across the UK, almost 1 in 3 women do not attend their cervical screening when invited, and this is as high as 1 in 2 in places such as London, with attendance reportedly falling over the last 20 years.

With fewer women coming forward to be screened since the pandemic began, it’s never been more important to ensure you’re being checked as regularly as the NHS recommends. 220,000 people with a cervix get an abnormal smear test result every year – which may seem daunting and scary for some.

But, the sooner you know the outcome, the sooner you can take the next steps that are best for your health. Plus, not all "abnormal cells" require treatment or necessarily lead to cancer.

GLAMOUR spoke to an expert and a woman who had an ‘abnormal cell’ result about what it all really means, including the importance of being regularly tested.

Why are cervical screenings important?

The key aim of a cervical screening is to identify whether the cells in your cervix show signs of abnormality, as well as if you are testing positive for the human papillomavirus (HPV) virus.

“HPV is a common infection of the reproductive tract that infects most sexually active women and men at some point in their lives,” Dr Sarah Welsh, gynaecologist and co-founder of sexual and intimate wellness brand Hanx, says. “And some people may be repeatedly infected.”

It’s perfectly possible (and probable) that you might have the HPV infection and never develop cervical cancer, but nearly all cases of cervical cancer are linked with HPV. So it’s always best to know – and the way to find out your situation is to have a screening.

What are all the possible outcomes of a cervical screening?

According to Dr Welsh, there are four potential results to your smear test – abnormal cells being just one of them.

  1. No HPV 
    “This is a ‘normal’ result, and you will simply be asked to come back for another screening in line with the National programme.”
  2. HPV is present but no abnormal cells
    “In this scenario you will be offered another cervical screening test earlier than the usual 3 yearly interval, to ensure you have cleared the HPV infection,” she says. “For most women, the next test will show no HPV.”
  3. HPV and abnormal cells
    “If you have HPV and abnormal cells, you will be referred for a procedure called a colposcopy. This looks at your cervix in more detail to find out more about the cell changes,” she says. “It will allow us to know if you need further treatment to remove abnormal cells.”
  4. An unclear result: “This means the laboratory could not get a result from the sample. This is nothing to worry about, but it’s important to have a repeated cervical screening test to gain an accurate result.”
What does having an abnormal smear test result really mean?

“Having abnormal cells means that you have changes in the cells covering your cervix. These changes are not cancer and will likely go back to normal on their own,” Dr Walsh says. “However, in some cases, if not treated, these changes can develop into cancer in the future.

“If you are found to have a high-risk HPV infection, you will be invited for more tests. It is important, however, to remember that HPV is so common and most women with the virus do not go on to develop cervical cancer with HPV.”

If you do have abnormal cells, you’ll also be informed of whether they are low or high grade (“this refers to the amount of cells which have changed,” Dr Welsh explains), as well as a ranking number which indicates how deeply the cell changes go through your cervical skin.

The ranking ranges from CIN 1 to CIN 3, depending on how deep the abnormal cells are throughout your cervical skin. It’s possible that lower-grade cell changes will go back to normal on their own, and for this reason some patients with “abnormal cells” will be told that nothing needs to be done.

But patients with high-grade changes will be recommended treatment due to the unpredictability of when the situation may escalate.  

What treatment is recommended for abnormal cells in your cervix?

The most common treatment for abnormal cells is Large Loop Excision of the Transformation Zone, known as LLETZ treatment.

Dr Walsh outlines what this entails: “A specialist will use a loop of thin wire with an electrical current running through it to cut through the tissue and remove the affected area. This should not be painful if you’ve had local anaesthetic, but you may feel some pressure down below.”

What it's really like to have abnormal cells in your cervix?

For Hollie, 25, finding out she had abnormal cells after having a cervical smear was a confusing and stressful experience.

“I received my results 3-4 weeks after my test. I was very anxious and upset to learn that I was HPV positive and abnormal cells had been found – known as low grade dyskaryosis,” she said. “When I had these results come back I found little information online, as I feel like smear tests, cell changes, and cervical cancer are just not spoken about as much at my age.”

She was somewhat surprised at her diagnosis, due to the fact she’d had her HPV vaccine as a teenager and thought that made her immune to cervical cancer. The reality of how the HPV vaccine works is different: “The HPV vaccine does not protect against all types of HPV that can cause cervical cancer,” Dr Walsh says. “Therefore, it's important that after receiving the HPV vaccine, you also attend your regular cervical screening appointments.”

Hollie admits that she struggled not to Google her condition, especially when she was about to receive treatment. “I was referred for a colposcopy, which is similar to a smear test, for further examination, and this is when I started to Google,” she said. “I struggled to sleep that evening – I would say Google was the worst thing I could have done, as I am an overthinker.

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“My family had all experienced cell changes after having children, and I found information suggesting that I may struggle to conceive (and worse) which just made my anxiety soar."

It’s important to arm yourself with the facts when it comes to the outcome of abnormal cells, particularly when it comes to long-term factors like fertility. “Having abnormal cells of the cervix does not affect your fertility or ability to get pregnant,” Dr Welsh says. 

“However, women who have had treatment on their cervix, including LLETZ and cone biopsies, are at increased risk of miscarriage and premature labour (giving birth before 37 weeks), because their cervix is weakened after treatment."

Hollie describes her initial examination as pain-free. "The doctor could see cell changes, which were only in one area and appeared low grade, but she wanted to take a biopsy to be sure. This is the part that I found painful, and I had some discomfort and bleeding afterwards.

“I cried because I felt anxious – it was a bizarre experience, a bit like being pinched and pulled inside – although the pain was totally worthwhile to potentially save my life. The nurses in the room with me were so lovely and made me feel very relaxed and safe.”

Above all though, Hollie’s experience hit home the importance of regular cervical screenings, and the complexity of what "abnormal cells" may mean. So, arming yourself with information and making the time to get checked is paramount.

“I've always understood that cervical screening is important but the messages we received as teenagers were blurred, and I think we were given a false sense of security that the vaccine meant that maybe we were less likely to get cervical cancer,” she says.

“I am so happy I acted on things when I did. I know so many friends that put off their smears for fear or because of busy lives. If I can encourage one person around my age to attend their smear test or get strange symptoms checked out, I would feel like this has been worthwhile.”

Cervical Cancer Prevention Week runs from 17th-23rd January, and Jo’s Cervical Cancer Trust are encouraging sharing of stories and tips around smear tests and results to help reduce some of the anxiety and fear they can bring. Join the campaign using #CervicalCancerPreventionWeek.

If you have questions, concerns or are affected by cervical cancer or cell changes, contact Jo's Cervical Cancer Trust for support.