Cervical Dysplasia

Cervical dysplasia is a precancerous condition in which abnormal cell growth occurs on the surface lining of the cervix or endocervical canal, the opening between the uterus and the vagina. It is also called cervical intraepithelial neoplasia (CIN). Strongly associated with sexually transmitted human papillomavirus (HPV) infection, cervical dysplasia is most common in women under age 30 but can develop at any age.

Cervical dysplasia usually causes no symptoms, and is most often discovered by a routine Pap test. The prognosis is excellent for women with cervical dysplasia who receive appropriate follow-up and treatment. But women who go undiagnosed or who don't receive appropriate care are at higher risk of developing cervical cancer.

Mild cervical dysplasia sometimes resolves without treatment, and may only require careful observation with follow up Pap tests. But moderate to severe cervical dysplasia usually requires treatment to remove the abnormal cells and reduce the risk of cervical cancer. Sometimes, mild dysplasia that has persisted longer than two years may be treated, as well.

Causes of Cervical Dysplasia

In many women with cervical dysplasia, HPV is found in cervical cells. HPV infection is common in women and men, and most often affects sexually active women under age 30.

In most cases, the immune system eliminates HPV and clears the infection. But in some women, the infection persists and leads to cervical dysplasia. Of the more than 100 different strains of HPV, more than one-third of them can be sexually transmitted, and two particular types -- HPV 16 and HPV 18 -- are strongly associated with cervical cancer.

HPV is usually passed from person to person during sexual contact such as vaginal intercourse, anal intercourse, or oral sex. But it also can be transmitted by any skin-to-skin contact with an infected person. Once established, the virus is capable of spreading from one part of the body to another, including the cervix.

Among women with a chronic HPV infection, smokers are twice as likely as nonsmokers to develop severe cervical dysplasia, because smoking suppresses the immune system.

Chronic HPV infection and cervical dysplasia are also associated with other factors that weaken the immune system, such as treatment with immunosuppressive drugs for certain diseases or after an organ transplant, or infection with HIV, the virus that causes AIDS.

Risk Factors for Cervical Dysplasia

Persistent HPV infection is the most important risk factor for cervical dysplasia, especially moderate-to-severe cervical dysplasia.

In women, an increased risk of a persistent HPV infection is associated with:

• Early initiation of sexual activity
• Having multiple sex partners
• Having a partner who has had multiple sex partners
• Having sex with an uncircumcised man

Diagnosis of Cervical Dysplasia

Because a pelvic exam is usually normal in women with cervical dysplasia, a Pap test is necessary to diagnose the condition.

Although a Pap test alone can identify mild, moderate, or severe cervical dysplasia, further tests are often required to determine appropriate follow-up and treatment. These include:

• Repeat Pap tests
• Colposcopy, a magnified exam of the cervix to detect abnormal cells so that biopsies can be taken
• Endocervical curettage, a procedure to check for abnormal cells in the cervical canal
• Cone biopsy or loop electrosurgical excision procedure (LEEP), which are performed to rule out invasive cancer; during a cone biopsy, the doctor removes a cone-shaped piece of tissue for lab examination. During LEEP, the doctor cuts out abnormal tissue with a thin, low- voltage electrified wire loop.
• HPV DNA test, which can identify the HPV strains which are known to cause cervical cancer.

Treatments for Cervical Dysplasia

The treatment of cervical dysplasia depends on many different factors, including the severity of the condition and the age of the patient. For mild cervical dysplasia, often only continued monitoring with repeat Pap tests is needed. For older women with mild cervical dysplasia, usually no treatment is needed unless mild cervical dysplasia has persisted for two years, progressed to moderate or severe cervical dysplasia, or there are other medical problems.

Treatments for cervical dysplasia include two of the procedures also used for diagnosis: cone biopsy or LEEP.

Other treatments include:

• Cryosurgery (freezing)
• Electrocauterization
• Laser surgery

Because all forms of treatment are associated with risks such as heavy bleeding and possible complications affecting pregnancy, it's important for patients to discuss these risks with their doctor prior to treatment. After treatment, all patients require follow-up testing, which may involve repeat Pap tests in six and 12 months or an HPV DNA test. After follow-up, regular Pap tests are necessary.

Prevention of Cervical Dysplasia

Women can lower their risk of cervical dysplasia by avoiding the high-risk sexual behaviors associated with HPV infection, such as early sexual initiation and having multiple sexual partners. Sexually active women whose male partners correctly use condoms during every sexual encounter may have up to a 70% reduced risk of HPV infection.

Other preventive measures include avoiding smoking and following the American Cancer Society guidelines for the early detection of cervical cancer, which recommend that every woman should begin cervical cancer screening at age 21.

Three vaccines -- Gardasil, Gardasil-9, and Cervarix -- have been approved by the FDA to help prevent infection with some types of HPV, including the types that cause most cases of cervical cancer.

According to guidelines endorsed by the CDC and the American College of Obstetricians and Gynecologists, boys and girls both should be vaccinated between ages 11 and 12 before they become sexually active; those between ages 13 and 26 who have not yet received the vaccine should also be vaccinated. The vaccine has been approved for women up to age 45.

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