Cervical Dysplasia

Sometimes screening tests show changes to the cervix’s surface, but these changes aren’t yet cancer. This is called cervical precancer, cervical dysplasia, or cervical intraepithelial neoplasia.

A pathologist will classify these changes as low grade or high grade. Most of the time cervical dysplasia, particularly low-grade dysplasia, will resolve on its own. Other times dysplasia requires treatment to facilitate resolution.

Between 250,000 and 1 million people are diagnosed with cervical dysplasia in the US each year. Most people are 25 to 35 years old, although it can occur at any age.

Risk Factors

HPV, the human papillomavirus, causes almost all cases of cervical dysplasia. Most sexually active people have this sexually transmitted viral infection at some point in their life. Most commonly your immune system clears the infection. If your immune system does not clear the virus, it can eventually lead to the development of cervical dysplasia and cervical cancer

Risk factors for cervical dysplasia are the same for cervical cancer. HPV infection, sexual history, history of other STIs, smoking, and weakened immune system.

Prevention

Getting the HPV vaccine, avoiding other risk factors and getting regular cervical cancer screenings between age 21 and 65 can prevent cervical dysplasia. The Advisory Committee on Immunizations recommends that girls and boys get the HPV vaccine at age 11 or 12, and no later than age 26.

Symptoms

Most people with HPV infection or cervical dysplasia have no symptoms. Symptoms don’t usually start until dysplasia becomes cancer. Regular screening with Pap smear and HPV tests is the best way to find cervical dysplasia before it becomes cancer.

Screening

Cervical dysplasia screening and cervical cancer screening are the same: regular Pap tests and HPV tests. Most people need these screening tests every three years from age 21 to age 65. Both are done during a gynecologic exam at your doctor’s office.

Diagnosis

Diagnosis of cervical dysplasia and cervical cancer are similar.

If your HPV and Pap tests come back with abnormal results, your doctor will examine your cervix using a colposcope, a magnification lens that looks for abnormal cells.

Should they see abnormal areas, they’ll take a small tissue sample, called a biopsy, or a deeper and more thorough scraping of your cervical canal, called an endocervical curettage (ECC). They’ll send the tissue sample to a pathologist, who will look for specific changes.

If the results show precancerous changes, your doctor will recommend treatment or follow-up. If they show cancer, you should be seen immediately by a gynecologic oncologist.

Treatment

Cervical dysplasia treatment depends on the type and severity of the dysplasia, overall health and medical history, and a patient's tolerance of certain procedures, medications, or therapies.

The most common treatments for cervical dysplasia are:

• LEEP (loop electrosurgical excision procedure). LEEP uses an electrified fine wire loop to remove precancerous tissue. LEEPs are an outpatient procedure done under local anesthesia.
• Cold knife conization. A scalpel is used to remove a cone-shaped portion of the cervix. This is an outpatient procedure done under general anesthesia.

Follow Up

Cervical dysplasia can come back, or recur, in the future, especially if you have a persistent HPV infection. You may need more frequent follow-ups with Pap and HPV tests or colonoscopies, every few months for the first couple of years after treatment. This is because some severe cases of dysplasia can develop into cervical cancer.