“My smear came back abnormal — do I have cancer? I’m terrified and I don’t understand the letter”

An abnormal cervical screening result terrifies patients, so lead with the central reassurance: cervical screening is SCREENING, designed to detect high-risk HPV and PRE-CANCEROUS cell changes EARLY so they can be treated before any cancer could develop — an abnormal cervical screening result is NOT a diagnosis of cancer. Explain HPV simply and WITHOUT BLAME: it is a very common sexually-transmitted virus that most sexually active people encounter, usually cleared by the immune system, able to lie DORMANT for years, and finding it does not imply promiscuity or partner infidelity — a frequent, distressing worry to address sensitively. Explain that DYSKARYOSIS (or CIN on biopsy) means abnormal but PRE-cancerous cell changes (not cancer), that low-grade changes often resolve spontaneously, and that changes needing treatment are highly treatable with simple procedures that effectively PREVENT cancer. Explain COLPOSCOPY — a magnified look at the cervix ± a small biopsy and, if needed, treatment (e.g. LLETZ, followed by a test of cure about 6 months later; CIN1 instead has a repeat screening test at 12 months), usually quick and done awake — framing it as prevention and describing what to expect to reduce fear and improve attendance. Reinforce the importance of ATTENDING colposcopy (non-attendance is a key risk), continued routine screening (from 1 July 2025, HPV-negative people aged 25–49 are recalled every 5 years), and accurate HPV VACCINATION information (it prevents new infection but does not treat an existing one; NHS eligibility runs to the 25th birthday, Green Book chapter 18a, so she is outside it at 29), and recognise that this is the cervical-SCREENING pathway (a colposcopy referral), distinct from an urgent suspected cancer pathway referral — though symptoms (abnormal, post-coital or intermenstrual bleeding) need face-to-face examination in their own right, and a cervix whose appearance is consistent with cancer warrants considering a suspected cancer pathway referral (NICE NG12). The communication core is fear of cancer and relationship distress; lead with accurate reassurance, explain HPV without blame, demystify colposcopy, validate the fear, check understanding, and ensure she attends.