Smear Tests

Smears

• Liquid-based cytology
• >25years every 3 years
• >49 years every 5 years
• >65 years only if previous evidence of dyskaryosis/cervical cancer

When to refer to the colposcopy clinic:

• after 3 inadequate samples
• and after mild, moderate or severe dyskaryosis, invasive smears & those with glandular changes.

Mild dyskaryosis/Borderline smear tests

• send to colposcopy clinic to redo smear & review in 9 months
• normal at 9 month smear, discharge to GP for repeat smears at 6, 12 & 24 months
• still mild dyskaryosis patient can either keep coming every 9 months to clinic or can have treatment if family complete/post-menopausal

Moderate & severe dyskaryosis smear

• send to colposcopy clinic to redo smear & review in 6 months
• If at 6 month review it is mild dyskaryosis or normal, keep reviewing every 6 months until 2 normal consecutive tests then discharge to GP
• If at 6 month review it is worse, offer treatment.

Invasive smear & those with glandular changes

• Must be seen within 2 weeks at colposcopy clinic

• If colposcopy confirms invasion – staging and cone biopsy
• If colposcopy suggests CIN only – LLETZ

Special Smear Test Cases

• HIV + women and those who are immunosuppressed should have yearly smears in a colposcopy clinic.
• Women with signs & symptoms (intermenstrual bleeding, post-coital bleeding etc) should be referred to a colposcopy clinic.

Follow-up to smear tests

Complete excision if CIN I

• Follow-up cytology (spatula + brush) with GP at 6months
• If  normal, repeat smear at 12 & 24 months and then return to normal screening.

Complete excision of CIN II & III

• Follow-up cytology (spatula + brush) with GP at 6 months
• If normal further smears at 12 months and then annually for a further 9 years

Criteria for follow-up in colposcopy clinic

• Positive margins (NB.post-menopausal women with positive endo-cervical margins require further treatment)
• Glangular change (NB. 6 monthly F/U required for 5 years in colposcopy)
• Involvement of crypts
• Micro-invasive disease

Things to get in if you can:

• Trials into testing samples for HPV at the moment in Manchester & Netherlands – women with mild dyskaryosis & negative for HPV could be returned to normal screening faster.