Cervical Dysplasia
Cervical dysplasia is a condition where abnormal cells grow on the surface of the cervix, but these cells are not cancer. While the word “precancerous” can sound frightening, most women with cervical dysplasia never develop cervical cancer, especially when the condition is found early and monitored or treated properly.
Table of contents
- What is cervical dysplasia?
- Other names
- Associated anatomy
- Stages of cervical dysplasia
- What causes cervical dysplasia?
- Risk factors
- Symptoms
- How is cervical dysplasia diagnosed?
- Treatment options
- Outlook and prognosis
- Prevention
What is cervical dysplasia?
Cervical dysplasia is a condition in which abnormal cells grow on the surface of the cervix, which is the lower part of the uterus that connects to the vagina[1]. The term “dysplasia” means abnormal cell growth. These abnormal cells are found on the surface layer of the cervix and have not spread deeper into the tissue[1].
Cervical dysplasia is considered a precancerous condition, meaning the abnormal cells might develop into cancer over time if left untreated, but they are not yet cancer[3]. However, most women with cervical dysplasia do not develop cervical cancer. Receiving a cervical dysplasia diagnosis means that you might — not that you will — develop cervical cancer[1]. Careful monitoring and treatments often prevent this from happening.
Between 250,000 and 1 million people are diagnosed with cervical dysplasia in the United States each year[4]. About 100,000 women receive treatment for cervical dysplasia annually in the U.S.[1]. Most people diagnosed are between 25 and 35 years old, although it can occur at any age[4].
Other names
Cervical intraepithelial neoplasia (CIN), cervical precancer
Associated anatomy
- Cervix
- Uterus
- Vagina
Stages of cervical dysplasia
Healthcare providers classify cervical dysplasia based on how much of the tissue looks abnormal when examined under a microscope. The severity ranges from mild to severe[1].
CIN 1 (mild dysplasia): Abnormal cells affect about one-third of the thickness of the surface layer of the cervix. CIN 1 rarely becomes cancer and often goes away on its own without treatment[1].
CIN 2 (moderate dysplasia): Abnormal cells affect about one-third to two-thirds of the surface layer. CIN 2 is more likely to require treatment to prevent cancer[1].
CIN 3 (severe dysplasia): Abnormal cells affect more than two-thirds of the surface layer. CIN 3 is the most serious form and is more likely to require treatment to prevent cancer[1].
When cervical dysplasia is detected on a Pap test, it may be described using different terms. On the Pap test report, abnormal changes might be described as low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), atypical glandular cells (AGC), or atypical squamous cells (ASC)[7].
What causes cervical dysplasia?
Cervical dysplasia is almost always caused by human papillomavirus (HPV), a common virus that spreads through sexual contact[1]. HPV is the most common viral sexually transmitted infection in the United States[1]. If you have cervical dysplasia, you have HPV. However, some women have HPV but don’t develop cervical dysplasia[1].
There are more than 200 types of HPV, but only some types can cause the development of abnormal cervical cells[2]. Over 100 strains of HPV exist, and in many cases, your immune system will get rid of the virus naturally[1]. However, some strains are considered high-risk because they are strongly linked to cervical dysplasia and cancer. HPV type 16 and type 18 are most commonly associated with cervical dysplasia and cause about 70 percent of cervical cancer cases[2]. HPV 16 alone is responsible for 50% of cervical cancer[8].
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[4]. The process is usually slow and occurs over several years[8].
Risk factors
Researchers don’t know why some women with HPV develop cervical dysplasia while others don’t[1]. However, several factors can increase your risk of developing cervical dysplasia.
Smoking cigarettes: Smoking and using products that contain tobacco can double your risk of cervical dysplasia[1]. Smoking weakens the immune system, making it easier for HPV to cause cancer[6].
Weakened immune system: Having a weakened immune system makes it harder for your body to fight an HPV infection[1]. This includes people with HIV or those using medicines that suppress the immune system[7].
Sexual history: Becoming sexually active before age 18, having multiple sexual partners, or having a partner who has multiple sexual partners significantly increases the risk of exposure to HPV[8].
Other factors that may increase risk include having three or more full-term pregnancies, having the first full-term pregnancy before age 17, giving birth before age 16, using oral contraceptives for longer than five years, and having other sexually transmitted infections[7].
The strain of HPV and how long you’ve had the untreated infection may also play roles in developing cervical dysplasia[1].
Symptoms
Cervical dysplasia doesn’t usually cause any symptoms[1]. Most people with cervical dysplasia don’t experience any symptoms, which is why regular screening is so important[2]. Doctors typically discover the abnormal cells during a Pap test[2].
However, some women may have irregular vaginal bleeding or spotting after intercourse[1]. If a woman with cervical dysplasia does have symptoms, they may include abnormal vaginal discharge, spotting between menstrual periods, bleeding after sexual intercourse, painful sex, or bleeding during menopause[2].
Most women who have cervical dysplasia find out they have it after a routine Pap smear[1]. Symptoms don’t usually start until dysplasia becomes cancer[4]. This is why it’s important to get screened regularly[6].
How is cervical dysplasia diagnosed?
Your healthcare provider may notice signs of cervical dysplasia during a routine internal exam[1]. Cervical dysplasia is typically detected during a routine Pap test (Pap smear)[6].
During a gynecological pelvic exam, doctors will insert a speculum into the vagina to widen it, so they can view the cervix at the top of the vagina. They then use a small swab or brush to scrape cells from the cervix’s surface[2]. This is generally not painful[6]. The cells are sent for analysis to determine whether they are normal or abnormal. It can take up to 3 weeks for the lab to process the test[6].
The Pap test results can be normal, inconclusive, or abnormal. If normal, you should follow your doctor’s recommendation for regular Pap tests. Inconclusive results don’t indicate cervical dysplasia. You could have a simple infection in your cervix or vagina. Your doctor may order a repeat Pap test[6].
If the Pap smear reveals abnormal cells, you may need additional tests[1]:
HPV test: An HPV DNA test can identify the high-risk types of HPV linked to cervical cancer. This test may be done as a screening test for women age 30 or more, or for women of any age who have a slightly abnormal Pap test result[7].
Colposcopy: Your provider performs an internal exam with a lighted magnifying instrument to check for abnormal cells in your cervix or vaginal walls[1]. This test lets your doctor look at the cervix through a magnifying tool[7].
Biopsy: Your provider removes tissue samples that a pathologist examines in a laboratory[1]. During a colposcopy, your doctor might also take a sample of cells for testing. A colposcopy is usually done before any treatment is given[7]. The biopsies are very small and most women feel only a small cramp[7].
Your healthcare provider will go over the results with you. Together, you’ll determine the next steps for treatment[1].
Treatment options
Not everyone with cervical dysplasia needs treatment[7]. Treatment depends on the degree of dysplasia[7].
Watchful waiting: Mild dysplasia (LSIL or CIN I) may go away without treatment. Changes due to HPV infection may also go away without treatment[7]. Your doctor may suggest waiting several months to have repeat testing to see if the dysplasia has gone away on its own[7]. You may only need careful follow-up by your provider with repeat Pap tests every 6 to 12 months[7]. Most of the time cervical dysplasia, particularly low-grade dysplasia, will resolve on its own[4].
If the changes do not go away or get worse, treatment is needed. Treatment for moderate-to-severe dysplasia or mild dysplasia that does not go away may include[7]:
Cryosurgery: This procedure freezes abnormal cells to destroy them[7].
Laser therapy: This uses light to burn away abnormal tissue[7].
LEEP (loop electrosurgical excision procedure): This uses electricity to remove abnormal tissue[7].
Cone biopsy: Surgery to remove the abnormal tissue[7].
Hysterectomy: In rare cases, surgical removal of the uterus may be recommended[7].
If you have had dysplasia, you will need to have repeat exams every 12 months or as suggested by your provider[7]. Even after treatment, dysplasia sometimes comes back. This is why it’s important to follow up with your doctor and have regular tests[7].
Outlook and prognosis
Early diagnosis and prompt treatment cures most cases of cervical dysplasia[7]. With regular screening and follow-up for abnormal results, cervical cancer is completely preventable. This is due to the fact that cervical dysplasia can be identified early and is easily treatable with low risk procedures[2].
However, without treatment, severe cervical dysplasia may change into cervical cancer[7]. If left untreated, more severe dysplasia may eventually develop into cervical cancer over time[2].
The condition may return even after treatment, which is why ongoing screening and monitoring are essential[7].
Prevention
Several steps can significantly reduce your risk of developing cervical dysplasia:
Get the HPV vaccine: One of the easiest and most effective ways to prevent cervical cancer and cervical dysplasia is by getting vaccinated against HPV[7]. The HPV vaccine protects against the types of HPV that cause 90% of cervical cancers and other diseases[4]. The vaccine is recommended for girls and boys between ages 9 and 12, with catch-up vaccination for everyone who is not adequately vaccinated through age 26. Adults 27 to 45 may get the vaccine after talking to their doctor if they were not adequately vaccinated when they were younger[4]. Girls who receive this vaccine before they become sexually active reduce their chance of getting cervical cancer[7].
Practice safe sex: Using condoms when you have sex can help prevent HPV infection. Use them from the beginning to the end of sexual contact[7]. Having a sexually transmitted disease can elevate the chances of developing cervical cancer. Adopting safer sex practices, such as consistent condom use and limiting sexual partners, can greatly decrease your risk[6]. While condoms help prevent HPV, they don’t fully protect you[6].
Don’t smoke: If you smoke, you should consider quitting, especially if you have other risk factors[4]. Smoking increases your risk of developing more severe dysplasia[7].
Get regular screening: Getting regular cervical cancer screenings between age 21 and 65 can prevent cervical dysplasia[4]. Beginning at age 21 (and through age 29), doctors may give healthy women a Pap test every 3 years to screen for cervical cancer. For healthy women ages 30 through 65, doctors may offer a Pap test every 3 years or a Pap test with HPV testing every 5 years[2]. Some women may need to be tested more frequently, depending on personal risk factors and prior test results[2].
Eat a healthy diet: Eating a healthy diet that includes plenty of fruits, vegetables, and whole grains provides essential vitamins, minerals, and antioxidants — all of which supports a strong immune system and can help reduce the risk of cervical cancer. Limiting red and processed meats, unhealthy fats, and sugars can further reduce the risk, as these have been linked to an increased risk of cancers[6].
