Cervical dysplasia

Causes

Cervical dysplasia is most often seen in women ages 25 - 35, but can develop at any age.

Most often, cervical dysplasia is caused by the human papilloma virus (HPV). HPV is a common virus that is spread through sexual contact. There are many different types of HPV. Some types lead to cervical dysplasia or cancer.

The following may increase your risk of cervical dysplasia:

• Having sex before age 18
• Having a baby before age 16
• Having multiple sexual partners
• Having other illnesses or using medications that suppress your immune system
• Smoking

Symptoms

There are usually no symptoms.

Exams and Tests

A pelvic examination is usually normal.

Cervical dysplasia that is seen on a Pap smear is called squamous intraepithelial lesion (SIL). These changes may be:

• Low-grade (LSIL)
• High-grade (HSIL)
• Possibly cancerous (malignant)
• Atypical glandular cells (AGUS)

If a Pap smear shows abnormal cells or cervical dysplasia, you will need further testing:

• Follow-up Pap smears may be recommended if the condition is mild 
• Colposcopy-directed biopsy can confirm it
• Cone biopsy or LEEP excision may be done after colposcopy

Dysplasia that is seen on a biopsy of the cervix is called cervical intraepithelial neoplasia (CIN). It is grouped into three categories:

• CIN I -- mild dysplasia
• CIN II -- moderate to marked dysplasia
• CIN III -- severe dysplasia to carcinoma in situ

Some strains of human papillomavirus (HPV) are known to cause cervical cancer. An HPV DNA test can identify the high-risk types of HPV linked to such cancer. This may be done:

• As a screening test for women over age 30
• For women of any age who have a slightly abnormal Pap test result

Treatment

Treatment depends on the degree of dysplasia. Mild dysplasia (LSIL or CIN I) may go away without treatment.

• You may only need careful observation by your doctor with repeat Pap smears every 3 - 6 months.
• If the changes do not go away or get worse, treatment is necessary.

Treatment for moderate-to-severe dysplasia or mild dysplasia that does not go away may include:

• Cryosurgery to freeze abnormal cells
• Laser therapy, which uses light to burn away abnormal tissue
• LEEP (loop electrosurgical excision procedure), which uses electricity to remove abnormal tissue (See: Electrocauterization)
• Surgery to remove the abnormal tissue (cone biopsy)

Rarely, a hysterectomy may be needed. If you have had dysplasia, you will need close follow-up, usually every 3 to 6 months or as recommended by your doctor.

Outlook (Prognosis)

Early diagnosis and prompt treatment will cure nearly all cases of cervical dysplasia. Sometimes, the condition returns.

Without treatment, severe cervical dysplasia may develop invasive cancer. It can take 10 or more years for cervical dysplasia to develop into cancer. The risk of cancer is lower for mild dysplasia.

When to Contact a Medical Professional

Call for an appointment with your health care provider if you are age 21 or older and have never had a pelvic examination and Pap smear.

See: Physical exam frequency

Prevention

Ask your health care provider about the HPV vaccine. Girls who receive this vaccine before they become sexually active reduce their chance of getting cervical cancer by 70%.

You can reduce your risk of developing cervical dysplasia by taking the following steps:

• Do not smoke. Smoking increases your risk of developing more severe dysplasia and cancer
• Get vaccinated for HPV between ages 9 and 26
• Do not have sex until you are 18 or older
• Practice safe sex, and use a condom
• Practice monogamy, which means you only have one sexual partner at a time

Alternative Names

Cervical intraepithelial neoplasia (CIN); Precancerous changes of the cervix

References

Cervical cancer in adolescents: screening, evaluation, and manage- ment. Committee Opinion No. 463. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2010;116:469–72.

ACOG Practice Bulletin No. 99: management of abnormal cervical cytology and histology. Obstet Gynecol. 2008;112(6):1419-1444.

Wright TC Jr, Massad LS, Dunton CJ, et al. American Society for Colposcopy and Cervical Pathology-sponsored Consensus Conference: 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcihnoma in situ. Am J Obstet Gynecol. 2007;197(4):340-345.

Wright TC Jr, Massad LS, Dunton CJ, et al. American Society for Colposcopy and Cervical Pathology-sponsored Consensus Conference: 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Am J Obstet Gynecol. 2007;197(4):346-355.

Kahn JA. HPV vaccination for the prevention of cervical intraepithelial neoplasia. N Engl J Med. 2009;361:271-278.

Douglas JM. Papillomavirus. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 381.

Apgar BS, Kittendorf AL, Bettcher CM, Wong J, Kaufman AJ. Update on ASCCP consensus guidelines for abnormal cervical screening: tests andcervical histology. Am Fam Physician. 2009;80:147-155.

Update Date: 2/26/2012

Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington;Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.