More than a quarter of women who receive slightly abnormal smear test results are experiencing unnecessarily high levels of anxiety – suggests new research published today (Tuesday) in the British Journal of Cancer*.

The report’s authors conclude that more information to help women understand their test results, and reassurance to address their fears about developing cervical cancer, could reduce anxiety levels.

The research team measured anxiety levels in over 3,500 women with slightly abnormal smear test results taking part in the TOMBOLA trial (Trial Of Management of Borderline and Other Low-grade Abnormal smears). The women were screened for clinically significant anxiety using the Hospital Anxiety and Depression Scale (HADS).

When the scores were analysed, 23 percent of the women were categorised as ‘probable cases’ of clinical anxiety, and a further 20 percent as ‘possible cases’. These findings are comparable with those from a study of women who had received higher-grade abnormal smear results.

Lead author, Nicola Gray of the Department of General Practice and Primary Care at Aberdeen University, said: “Our results indicate that similar levels of anxiety are being experienced among women with slightly abnormal – or low-grade – smears as among those with high-grade smears.

“This suggests that women may not understand their test results or the meaning of the term pre-cancerous, and wrongly conclude that any abnormalities detected must indicate cancer.”

The results also showed that women at highest risk of anxiety tended to be younger, have children, be smokers or have the highest levels of physical activity.

A slightly abnormal test result rarely means that a woman has cervical cancer. It means that some of the cells on the smear were slightly abnormal and could become cancerous sometime in the future.

In the vast majority of cases these slightly abnormal cells go back to normal by themselves and the doctor will ask the woman to come back in six months for a repeat smear to make sure. Alternatively, the doctor will carry out another examination called a colposcopy to examine the cervix more closely and take action to treat the cells if necessary.

If a woman is treated for an abnormal smear she is very unlikely to go on to develop cervical cancer.

Nicola Gray added: “Strategies to improve women’s understanding and to address their fears about cancer, treatment and fertility are needed to reduce this anxiety.”

Martin Ledwick, cancer nurse manager at Cancer Research UK, which owns the British Journal of Cancer, said:

“It’s vitally important women understand that smear tests are all about cancer prevention. The test detects abnormal cells that could become cancerous and follow-up treatment prevents cervical cancer from developing.

“The national screening programme is estimated to save thousands of lives in the UK every year. But if women are worried unnecessarily by the results of their smear the concern is they won’t continue to go for regular checks.”

The Medical Research Council (MRC) and the National Health Service (NHS) in Scotland and England funded the research.


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Psychological effects of a low-grade abnormal cervical smear test result: anxiety and associated factors. N. Gray, et al. British Journal of Cancer (2006) Vol 94, issue 9.

Almost 3,000 new cases of cervical cancer are diagnosed in the UK each year. It can affect women of any age who are, or once were, sexually active and is the second most common cancer in women under 35.

Scientists have linked nearly all cases of cervical cancer to human papillomavirus or HPV. Most sexually active women will be infected with HPV at some point as it is very common but the virus usually clears up on its own.

If HPV persists it can lead to changes in the cells of the cervix that may lead to cancer if left untreated. Cervical screening detects these early changes and the abnormal cells can then be removed thereby preventing cancer developing.

To download a leaflet about reducing your risk of getting cervical cancer, go to the visit: Cancer Research UK Leaflets Section. Or send a stamped addressed envelope to CC Prevention, Cancer Information Department, Cancer Research UK, PO Box 123, London WC2A 3PX.

Half of all cancers could be prevented by changes to lifestyle. Cancer Research UK’s Reduce The Risk Campaign urges people to go for screening when invited. In the case of cervical screening early detection of abnormalities will save thousands of lives.

For more information about cervical screening, cervical cancer and treatment, visit Cancer Research UK’s patient website.