Treatment for abnormal cervical screening results; the risks and benefits.

If you've made an informed choice to participate in cervical screening, then it's likely at some point that you'll have an "abnormal result", which might leave you feeling scared, anxious, and worried about getting cancer.

In fact 1 in 20 women will get an abnormal result (5%), whilst only 1 in 2000 will have cancer found (0.05%).

(source: https://www.bsccp.org.uk/women/frequently-asked-questions).

These abnormal results are due to the detection of cells which have changes to their normal appearance under a microscope. They aren't cancer, but there is a chance that they could become cancerous. Here are the risks of that happening:

There are 3 levels of "abnormality", CIN1, 2 & 3, with CIN3 being the most likely to progress to cancer (invasion). Although even at CIN3, we can see that the risk is just 12%. 

Having had an abnormal result, you have some options available to you. With CIN1 you would almost always "wait and watch", as the abnormal changes are caused by HPV infection, a sexually transmitted virus, which in most cases the body will clear by itself.

If you have CIN2 or 3, whilst the risk of cancer is still relatively low, you will likely be offered treatment.

The mainstay of treatment for CIN2 & 3 is a procedure called LEEP (Loop electrosurgical excision procedure), also known as LLETZ (Large loop excision of the transformation zone).

This involves taking an electrically charged wire loop to remove a chunk of the cervix where the abnormal cells are. It looks like this:

There's also a video showing the procedure on YouTube (viewer discretion is advised): https://www.youtube.com/watch?v=z6_Yb8ad_9g

So, the idea is that they cut away the chunk of your cervix with the abnormal cells (which are in the top layer of skin, but for some reason they take a huge chunk away!), and you go merrily about your life with no more worries of cancer. Sounds good right!

Sadly it's not always that way. As with all procedures, there are risks. Some physical, some mental, often both.

LEEP & LLETZ (they're the same thing) potential complications include:

Infections of the cervix can occur, and occasionally
infection may be introduced into the uterus, Fallopian tubes or other pelvic organs. This may require treatment with antibiotics and further treatment.

Bleeding could occur from the cervix and may require a

blood transfusion, a return to the operating room or other

measures, such as vaginal packing, to control the bleeding.

Damage and narrowing of the cervix could occur which

can cause painful periods and difficulty in labour.

Complete closure of the cervical canal, which can cause

difficulty in having a period, pelvic pain, infertility and

difficulty obtaining a pap smear. The cervical canal might

require dilatation under anaesthetic and on some occasions

it may require having a hysterectomy (removal of uterus).

The cervix may be weakened which can lead to early

pregnancy loss and the occasional need to strengthen

the cervix during a pregnancy by the insertion of a special

stitch (cervical cerclage). The risk of preterm labour is also

increased. Women who have had a prior LLETZ procedure

may have to have their cervix length measured regularly by

ultrasound during pregnancy to ensure it is not shortening

or opening too early.

Blood clot in the leg causing pain and swelling. In rare cases, part of the clot may break off and go to the lungs.

Small areas of the lung can collapse, increasing the

risk of chest infection. This may need antibiotics and

physiotherapy.

Heart attack or stroke could occur due to the strain on the heart.

Damage to surrounding organs such as bladder, rectum

etc. and further surgery may be required to rectify this.

Subsequent infertility.

Miscarriage or premature labour can occur, usually from

12 weeks onward in future pregnancies, as a result of

weakness of the cervix. This is relatively more common if

this procedure has to be done more than once .

Hysterectomy (removal of uterus) if bleeding is unable to be controlled.

(Source: https://www.health.qld.gov.au/__data/assets/pdf_file/0035/147887/obst_gyna_23.pdf)

Wow, that's a long list! So those are the official complications, as found in the consent form in the source link above.

So is that all we have to worry about? Looking at women's stories in the media and online, it seems not, sadly.

Women have complained of suffering from weakened stomach muscles, a loss of libido (desire for sex), loss of orgasm and painful sex.

(Source: https://www.dailymail.co.uk/health/article-5960067/The-women-say-treatment-smear-test-RUINED-sex-lives.html)

So, a treatment which isn't even for cancer, but rather some cell changes that just might become cancer, could leave you infertile, in constant pain, lacking a sex drive, or orgasmic ability.

Should you accept this treatment? 

That's really up to you. There is a risk of cancer, but there's also a chance that you'll be absolutely fine.

But if you do, do so knowing all the risks and benefits. This information is not always given to women, and it should be.