Smear test callback and a friend's tragic diagnosis
Our GP advises on smear test abnormalities and the inevitably fatal consequences of CJD.
Question: I had a smear test done recently and just got a call from my GP saying there is an abnormality and I need to undergo a test called a colposcopy. Should I be worried?
Dr Nina replies: Most abnormalities found on smears are totally treatable. About one-in-20 women who are screened will have some abnormal cells found. Less than one-in-1,000 women who are referred for colposcopy are found to have cancer that requires immediate treatment
There are a number of possible results of smears. A smear test may be reported as 'inadequate'. This means it couldn't be read properly. This can be due to the fact that there weren't enough cells gathered; they couldn't be seen clearly enough; or the view was obscured due to an infection. 'Normal' is a very reassuring result and in this case, your next smear is required in three or five years' time, depending whether you are under or over 45.
'Abnormal' smears are divided into low or high-grade change. If your smear shows low-grade change, the same will also be tested for the HPV virus. Certain strains of HPV are associated with an increased risk of cancer of the cervix. If you test positive for HPV, you will be referred on to have a colposcopy. If you test negative, your risk of cancer is very low and you can continue routine cervical screening.
Colposcopy is the next step for those with high-grade change or who are HPV positive. Many are worried when they are referred on for further assessment, but it is important to realise that this is simply the next step in the screening process. Colposcopy usually happens in an outpatient clinic in hospital.
A speculum, similar to that used for a smear, is inserted to provide a good view of the cervix. The colposcope remains outside the body and acts like a microscope to give a clear view of the cells on the cervix. A small sample may be taken and sent for further analysis.
This shows normal cells in about 40pc of cases. Further treatment may be required for those who are found to have abnormal cells.
LLETZ treatment involves using a heated loop to remove abnormal cells from the neck of the cervix. This may be performed the same day and is usually done using a local anaesthetic.
It is a successful procedure in about 90pc of cases.
If you have had abnormal cells removed by LLETZ procedure, you will require closer surveillance for a number of years before returning to regular screening.
Question: A friend of mine was admitted to hospital a number of weeks ago having lost his speech. His family have just been told he most likely has CJD. How quickly will this progress and what is the outlook for him?
Dr Nina replies: Creutzfeldt Jacob Disease (CJD) is an extremely rare condition that affects the brain. Most of those affected are dead within a year of diagnosis, often sooner. The disease received a lot of publicity in the late 90s and noughties when cases were linked with the ingestion of infected beef. The majority of cases, however, occur sporadically.
CJD infects about one-in-a-million people worldwide per year. It usually affects those over the age of 60.
Initial symptoms can be vague. There may be changes in speech or balance or personality. It can be confused initially with early dementia or other neurological conditions.
The main difference is that symptoms progress rapidly in CJD. Patients may develop involuntary jerks. They can go blind and lose the ability to speak, eventually slipping into a coma.
Pneumonia and other infections can occur leading to death.
The cause of CJD is unknown. It belongs to a group of disease called Transmissible Spongiform Encephalopathies. Spongiform refers to the spongy holes that occur in brain tissue which are visible under a microscope. In CJD, there are abnormalities of proteins called prions in brain tissue. In 85pc of cases, there is no obvious cause. This is referred to as sporadic CJD. In about 5-10pc of cases, there may be a familial link.
A very small amount of cases have occurred due to exposure to infected human tissue during medical procedures. This is referred to as iatrogenic CJD.
Many drugs have been tried in the treatment of CJD, but unfortunately, none have been successful. The main focus of care is on keeping the patient comfortable. CJD is an inevitably fatal disease.
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