Abnormal smear and pregnancy

[ThreeBees]

I've just had a "borderline" smear result (I presume CIN 1) with a request to come back in 6 months for a repeat. There are many reasons why I really want to be pregnant by then with DC2 (hormonal, financial, age, career).

What would you do? I have minor changes which will probably go away by themselves, but with maybe a 10% chance of them progressing into worse pre-cancerous changes. Do I continue TTC to then put my repeat smear off for another 6 months? Or do I wait for my repeat smear and then try and get preggers? Far later than I'd wanted for reasons above.

Does anyone have any experience of this?

Borderline doesn't even mean CIN1. So you may not even have HPV and if you don't have HPV, then you aren't at risk from getting CIN. Could you afford to pay for an HPV test and repeat smear earlier than the normal 6-month time? If they both come back clear then you know not to worry at all about getting pregnant; if the smear comes back clear but the HPV test is positive for high risk HPV then you know to be vigilant and get tested again after you've had your baby (presuming you do get pregnant soon, as planned); and if they come back with a more definitive result (eg CIN 1 or above), then you can decide what to do on a stronger base of knowledge, having got advice from a medical professional on the risks. I, as a non-professional, wouldn't have thought there is much of a risk of a cervix with borderline changes prior to pregnancy having such rapid changes during pregnancy that you end up with cancer after only 9 months (although anything in life is possible), and anything less than cancer is generally easily treated.

I think it is also possible to have a smear test while pregnant, although in this country I don't think they normally do that unless there is a very good reason to, particularly since once you are pregnant they are unlikely to want to treat it, anyway, but will just keep an eye on it until after the birth (if there is anything there worth keeping an eye on...).

Thanks guys.

SaF, the policy here is to repeat the smear after 6 months and I think then if there are still changes to go on to colposcopy.

I just don't see how these borderline changes can go on to be horrendous in 12 months. And if I wait I'm in a lose/lose situation - either the repeat smear's normal, in which case I've waited for nothing (although at least I don't have cancer!), or it's abnormal and I need treatment, but I STILL don't get to be pregnant.

But maybe I'm being reckless. I just don't know.

SaF, I hope you're well now.

Rabbbit, do you work in some kind of medical field?

How ironic. I spelt your name with three b's rabbit!

Hi, ThreeBees,

No, I don't work in any kind of medical field, although come from a medical family, so spent most of my childhood talking about things medical! I know quite a bit about abnormal smears and their causes, colposcopies and treatment from personal experience, having had to have smears every 6-months to a year for the last 12 years, as I've regularly had abnormal cells that until a few years ago always returned to normal 6 months later, then had a CIN3 result followed by (my first, despite my history, as they tend to do colposcopy only after at least two abnormal results in a row unless CIN2 or above) colposcopy and treatment, then had another severely abnormal smear report and treatment that turned out in that case to have been unnecessary as I did not have a repeat of CIN - just metaplasia and non-specific inflammation. So, on the basis I feel I know an awful lot about the subject, having been given much cause for concern myself in the past and therefore done much research on it!!!!!

Sorry that the two of you know so much because of personal experience, but your advice is very much appreciated .

ps I think swallowedAfly is right - there is little genuine risk in getting pregnant now. There is the possibility your smear result is inaccurate of course (either as in there is no abnormality at all, or as in the abnormality is more severe than indicated), as only a biopsy of the abnormal area (if any abnormality is actually seen) taken during colposcopy can give an accurate picture of what is going on. Even knowing for certain that you have, eg, CIN1, doesn't completely answer your question about the safety of getting pregnant, though, of course.

Borderline is a bit of an annoying result, basically, because it doesn't confirm anything at all, except that some of the cells that the smear taker took look a bit odd, but not odd enough to be certain what the cause is, hence an HPV test possibly being helpful, as you really don't have to worry at all about your borderline smear result progressing to CIN or cancer without HPV being present. I would have thought a private HPV test is going to be cheaper than a private colposcopy.

You could, of course, go and discuss all this with your GP and see what he or she can arrange for you on the NHS, given your circumstances (if anything at all beyond waiting six months as already indicated). He or she could also advise on the official medical position on women wanting to get pregnant while awaiting repeat smears - I suspect it is not uncommon for women to be in your dilemma and therefore the GP might well have some ready answers for you.

pps if I were you, I'd probably be tempted just to keep ttc, but would have a word with my GP first.

This is exactly what happened to me. I had an irregular result and was asked to come back in three months. But a month later I discovered I was pregnant. My gp said no worries, we will just wait. My gyny said to do another one, which I did, but the result was imperfect as pregnancy can cause bleeding.

Anyway, I had another one a few months after the birth, and it was fine. I just wish I had known that before falling pregnant as it was always in the back of my mind.

OP, I had exactly the same as pinkhouses - smear in October 08, abnormal result (borderline changes) so asked to come back in 6 months. By then I was pg and was told there was no point in doing one because of the hormonal changes in pregnancy, so I had one done in Feb this year when DS was 3 months old and it came back normal. I wouldn't let it stop you ttc - go for it!

Hi
NHS CSP publication
Page 42:
"10.1 Pregnant women
10.1.1 Cervical screening in
pregnancy
Unless a pregnant woman with negative history has gone beyond
three years without having cervical screening then the test should
be postponed.
? If a woman has been called for routine screening and she is pregnant
then the test should be deferred.
? If a previous test was abnormal, and in the interim the woman becomes pregnant, then the test should not be delayed but should be
taken in mid-trimester unless there is a clinical contraindication."

Having an earlier repeat will probably not help because it depends, as rabbitstew says on what caused it. The GP would be able to give you more advice.

If we're talking CIN (histology) not abnormal cytology especially in reference to borderline changes, then various studies have come out with over 95% association with high risk types of HPV for CIN. It has also been suggested that those that weren't positive (usu in early studies) may be due to the techniques used developing further over the years. Bosch et al review in 2000 (could be 2002) is v.good review of the evidence.

Next, I?d like to discuss the impact of your most-cited paper for the time span 1998-2008, "Human papillomavirus is a necessary cause of invasive cervical cancer worldwide," (Walboomers JMM, et al., Journal of Pathology 189:12-19, 1999). It really establishes the relationship between HPV and cervical cancer worldwide.

The precedent for my #1 paper in the analysis is, however, our 1995 publication in the Journal of the National Cancer Institute, in which I was the lead author, "Prevalence of human papillomavirus in cervical-cancer?a worldwide perspective," (87[11]: 796-802, 7 June 1995). That paper is one of the most quoted in the field. It is a prevalence survey describing the HPV DNA profile of over 1,000 specimens from 33 countries. The breakthrough in that paper was to set the prevalence of HPV DNA in cervical cancer at the 93% level and to show the consistency internationally.

"The number of [HPV] cases worldwide is close to half a million, of which more than 80% occur in developing countries, where the lack of access to medical facilities inevitably leads to high mortality in a relatively young age group."

However, from the results we were still left with 7% of cases that were apparently unrelated to HPV. On a second step, we identified those 7%, retrieved the specimens, and sent them to the late Jan Walboomers, who at the time was the head of the HPV research laboratories at the Free University in Amsterdam. He and his colleagues had developed a slightly different technology for detecting and typing HPV DNA. In the 7% apparently HPV-negative samples where he could retrieve cancer cells amenable for proper HPV testing, he found HPV DNA in virtually all of them.
So Paper #1, in which Jan is the leading author, is highly cited because it expanded and completed the 1995 results to show that virtually 100% of cervical cancer had HPV DNA?the necessary cause. This paper is important because it was the first time in cancer epidemiology in which a necessary cause was declared.
Excerpt fron interview with Bosch
and this is the review paper: (Bosch FX, et al., "The causal relation between human papillomavirus and cervical cancer," Journal of Clinical Pathology 55: 244-65, 2002)

Thanks very much guys. Lots to think about. I'm still swinging wildly between going for it (at least for the next 2 months where there is a major financial incentive!) and just waiting and not being so daft.

I had an 'abnormal' smear about 12 years ago and was told to come back for a repeat in six months. Being an anxious little soul I went to Marie Stopes in London after three months and paid for a private one, which was normal, as was the NHS one after six months and all others since. I think (without being au fait with the all the research quoted above!) it's not at all uncommon for a test to show 'slight abnormalities'. So you could always pay for another one (can't remember how much but it's not too expensive) before six months.

At the time for some reason (type of pill?) I often suffered from mild thrush. It was suggested that I took a treatment for this before the second smear as sometimes that can skew the result. (For what it's worth - please those of you with better scientific knowledge don't flame me!).

Er, so do you win a bet if you get pg in the next two months???

Yup, bet someone a few grand .

No. I'm having to work full time for 3 months later in the year. If I get up the duff in the next 2 months it'll fall in the time they calculate my maty pay, thus £££.

All sounds very mercenary, but we were planning another one now anyway, just would be nice to exploit the loophole .

Go and exploit!...

I would get one of those more high-tech brush smears done privately and see what that said.

Haven't they rolled out liquid based cytology and brush smears to all NHS areas already? I know they already do this on the NHS where I live, as my last two smears (I have to go back every year) have been done this way.

Yes all NHS labs/primary care should be using LBC. All PCTs had to be converted by the of 2008.

I would be tempted to stick with your plans. I would also ring your GP and ask if he could refer you to someone at a hospital gynaecology department to advise you. I have had treatment following an abnormal smear test but mine was an extreme case and found early luckily. If there was anything that was a concern they would have you in immediately for treatment.I had CGIN, CIN 3, and dyskaryosis(sp?) and had pre cancerous cells.I ended up having a cone biopsy and luckily biopsies came back clear after this.In total this was about 16 weeks from initial smear to all clear. I have now had 3 further 6 month tests and all have been fine but if I had wanted to conceive this would have been a very long time to wait.
Good luck

Hi, Ihatebeingfrugal,

I think dyskariosis and pre-cancerous cells are the same thing as CIN, just different ways of saying it. Severe dyskariosis is certainly the same thing as CIN3. CGIN is different in that it is an abnormality of the glandular cells of the cervix, which is a far more unusual abnormality and should always be treated as soon as possible because it can turn cancerous and spread far more quickly than CIN. Any smear report will make it quite clear if the suspected abnormality is in the glandular cells, as prompt further investigation of this is very important. I don't think a report indicating borderline changes indicates any concern at all about glandular cells, hence no need to go straight off to have a closer look, as the chances are far greater everything will return to normal if left alone than that anything will develop. At least that's my understanding - BellaLugosiNoir will know!!!