1.1 Cervical cancer & cervical smear
Cervical cancer is one of the most common cancers in Hong Kong. In 2016, there were 510 newly diagnosed cases of cervical cancer. Early-stage cervical cancer can have no clinical symptoms at all, and without cancer screening, it may not be detected in a timely manner. If not properly treated, cervical cancer can worsen and even progress to an advanced stage, which can be life-threatening.
The precursor stage of cervical cancer can have a latent period of 9-15 years. If cervical cell abnormalities can be detected through cervical cell testing before they become invasive cancer, appropriate medical interventions can be initiated early. Therefore, regular cervical smear tests are crucial. Cervical smear test is currently the most accurate and convenient screening method for cervical cancer. It can effectively detect precancerous cervical lesions and assist doctors in providing appropriate treatments, thus improving the cure rate and prognosis of cervical cancer patients.
Medical research has shown that if precancerous lesions are detected during cervical smear testing and timely treatment is provided, the five-year survival rate can exceed 90%.
1.2 How is a cervical smear obtained?
The cervix is located at the tip of the uterus and connects the uterus to the vagina. While obtaining a cervical smear, a healthcare professional will insert a speculum into your vagina, which allows them to clearly visualize the cervix at the top of the vagina.
The healthcare professional will then use a wooden or plastic spatula called an Ayre’s spatula to gently scrape the surface of the cervix to collect cell samples. These cells are then spread onto a glass slide and fixed with a spray fixative before being sent to the laboratory for examination.
During the process, you may experience slight discomfort, but there should be no pain involved.
1.3 Results of cervical smear
| Results | Details | Recommended Follow-up Actions |
| Negative | No abnormal cells detected | Continue with regular screening |
| Insufficient | Sample has inadequate cells or is not optimal | Recommend retesting |
| Atypical Squamous Cells of Undetermined Significance (ASCUS) | Mild cellular abnormalities that often resolve spontaneously | Recommend a follow-up within six months. If the follow-up reveals persistent or worsening abnormalities, a colposcopy examination is needed. Alternatively, undergo a high-risk HPV test as soon as possible. If the test result is positive, immediate colposcopy examination is required. |
| Atypical Glandular Cells of Undetermined Significance (AGUS) | Abnormal cells present within the cervix | Recommend cervical sampling for evaluation every three months or undergo colposcopy examination |
| Low-Grade Squamous Intraepithelial Lesion (LGSIL) | Mild cellular changes that are likely to regress within 2 years (approximately 85%), while approximately 15% may progress | Recommend colposcopy examination or biopsy |
| High-Grade Squamous Intraepithelial Lesion (HGSIL) | Moderate to severe cellular abnormalities, with a 1-2% risk of progressing to invasive cancer | Recommend colposcopy examination or biopsy and treatment. After successful treatment, regular cervical sampling should be performed. |
| Invasive Cancer | Presence of cells indicating cervical cancer transformation | Immediate diagnosis and appropriate treatment for cervical cancer are necessary |
1.4 Do I need a cervical smear?
Gynecologists recommend that all sexually active females should begin regular cervical smear screenings starting from the age of 25 to detect early-stage cervical precancerous changes.
If the results of the first cervical smear are normal, the doctor advises undergoing a second screening after one year. If the results of the second screening are also normal, subsequent screenings can be performed every three years.
Additionally, although the HPV vaccine can prevent infections from high-risk HPV types, it does not protect against all types of HPV infections. Therefore, even if someone has received the HPV vaccine, it is still recommended for eligible women to undergo regular cervical smear screenings.
1.5 Is cervical smear accurate?
Cervical smear tests are not absolutely accurate and can have a false positive or false negative result rate of about 5-20%. Therefore, if there are any issues with the test results, doctors may recommend further examinations to establish a diagnosis. If you have any questions, please feel free to ask the healthcare professionals at our center.
1.6 Preparations for cervical smear
Please avoid the following activities within 48 hours prior to the examination, as they may wash away abnormal cells in the cervix and affect the accuracy of the test:
- Sexual intercourse.
- Using spermicidal products or vaginal suppositories.
- Vaginal douching.
Additionally, if you are currently menstruating, it is advised to reschedule the examination. If you notice any abnormal vaginal discharge or inflammation, please consult your doctor before undergoing the examination.
It is normal to experience minimal vaginal bleeding for one to two days after the examination. There is no need to be overly concerned. However, if the bleeding persists, please contact the healthcare professionals at our center for further follow-up.