Confused re smear test recall

[friendlymum67]

I have a history of abnormal/borderline results and was referred to colposcopy because of this. However whilst looking thro the paperwork today, my last smear was normal (Nov 12) but I have to attend again in a year's time. I don't understand this - is it something to do with the HPV testing and does this mean I have tested positive for HPV but they haven't told me.

Worried and confused!

After having an abnormal/borderline smear and subsequent colposcopy I then had a normal smear. I still had to attend every 6 months for a year, then yearly for two years, before finally going back to 3 yearly. Think it's just precautionary. HTH

Tks Bangers - altho I was referred to colposcopy nothing abnormal was found. Was this the case with you? Our recall/repeats do seem very similar - just surprised a only a year's interval but from what you're saying, maybe it is just precautionary. Was concerned about the HPV thing as from what I've read, it can mean a heightened risk of cervical cancer, tho I guess they would have to tell me if I had tested positive -wouldn't they??

Sorry for sounding so neurotic! I should stop googling and mumsnetting!

Yes my colposcopy was clear too. They said the most likely reason for my abnormal cells was hpv as this is known to cause the pre-cancerous cells which lead to cervical cancer. Apparently as many in one in ten people have the virus. I didn't need any treatment though.

I read that the majority of women will have the virus at sometime in their lives, but they won't get Cervical cancer. The fact that some women with cervical Cancer also have the virus, is not conclusive that the virus causes it.

They are being extra cautious to be on the safe side, as in some women it maybe one of many contributing factors that causes Cervical cancer.

Do not worry.

Hi
Could you check exactly what the result letter says please, as I'm not sure from what you've posted whether you've been referred to colposcopy recently.
From the history you've given it sounds like you went to colposcopy before (what was the outcome?) and this recent test in Nov was a follow up.

It is usual to have follow up cytology samples (smear test) after colposcopy. How many and the frequency depends on your previous smear results and what happened at the colposcopy appointment. Usually there would have been a colposcopy visit outcome letter which would give the result and what follow up you're supposed to have.

I had three borderline results and had a smear every 6 months, then one normal and I was told I would be tested yearly from now on. No HPV screaming took place. I think it is routine to have yearly if you have a history of borderline or abnormal.

MrsSham the follow up is sometimes different if you've been for investigation, depending on what the colposcopy showed.
At present HPV testing is done on borderline and mild cytology if your last test was negative routine recall or negative, borderline or mild cytology if you have just had treatment that showed CIN1-3.
From around April this will be extended to all borderline or mild cytology (e.g. If your last test showed borderline and this one does) and to all women on annual follow up after CIN if their cytology is negative, borderline or mild.
If the HPV test is positive you're referred to colposcopy for investigation, if it is negative then you'll go to 3 or 5 year recall.

I have just had reminder for my next smear and was advices I would be routinely tested for HPV on this one. My last was normal. Will be interesting to see what the outcome is, I'm a bit nervous now.

I don't understand the process either.. I've had 2 colposcopy exams where they have taken biopsies of the area and yet they one back clear?? Can the biopsy miss it?

Perhaps they found HPV and was a precautionary procedure, but your cells were normal as has happened with a few of the posters on this thread.

W old they not be obliged to tell you if they found HPV or that they were even screening for it?

I've not been screened for HPV as they didn't routinely do it, they do now but ironically now my latest smear was moderate they dont screen for those only mild/borderline.

Ladygoinggaga - what were your results that you were referred to colposcopy with?
Colposcopy assessment is subjective, it depends on interpretation of the change seen on the cervix. Some of the changes which are active (+normal) can look quite similar to abnormal change (because abnormal cells are also very active).
So the colposcopist may have sampled the correct area but it is actually ok.
Rarely a biopsy could miss the worst area on the cervix but (a) if that happens its likely to be a very small area and (b) this is another reason for having follow up tests to check the abnormality has gone.

I had biopsies taken again, third time. I could see a new large white patch that wasn't there 6 months ago, she compared it to a slide taken last time and it was new.
The doctor was cautious much more so than last few times.

If you're screened for HPV as part of routine screening then your result letter will tell you. The result is sent through to the result processing agency in code form so the letter will be automatically written based on the codes. E.g.
Mild cytology and HPV positive is sent to the result agency as M9S (M= mild, 9=HPV positive, S= refer to colposcopy).
The HPV testing is used as a triage to assess who needs colposcopy investigation. If your smear shows moderate then you do need investigation, so HPV testing wouldn't routinely be carried out.
Ladygoinggaga - did you have the moderate before or after the two colposcopies?

Sorry cross posted. I'm guessing they've been cautious due to the previous biopsies being ok. Are they going to discuss your case at an MDT (patient case review meeting)?

I've had 3 years of mild/borderline, 3 colposcopy's. Then smear few weeks ago showed moderate for first time, back to colposcopy for fourth time!

I'm doing it now, whoops! Yes she did mention MDT

The cells can be difficult to interpret, particularly metaplastic cells (which are normal very active cells). When you're reading a sample there can be a fine line between ok metaplastic cells and abnormal ones.
The MDT will usually be colposcopy staff, cytology and histology staff. All the slides are retrieved and reviewed, and the case notes. It's really helpful to gt other opinions and then suggest what would be suitable. They may suggest HPV testing at this point if they think it will be helpful. It also depends on what your latest biopsies show.

Thank you for explaining about the two different cell types, makes sense now.
Yes just waiting for latest biopsy result now, so fingers crossed. I'm a positive person but a small part of you worries with things like this!

The metaplastic cells can also become abnormal as well as being normal so that's why they can cause problems trying to investigate and treat. Hope you get an answer from this biopsy.
To give an idea of what the cytology (smear sample) looks like and compare the two states -
normal metaplastics and abnormal metaplastics (moderate).