Cervical Dysplasia

Cervical dysplasia is a condition in which healthy cells on the cervix undergo some abnormal changes. The cervix is the lower part of the uterus that leads into the vagina. It is the cervix that dilates during childbirth to allow the fetus to pass through. In cervical dysplasia, the abnormal cells are not cancerous, but can develop into cancer if it is not caught early and treated.

According to the Johns Hopkins University Kimmel Cancer Center, every year in the United States, cervical dysplasia affects between 250,000 and 1 million women. (JHU) It is most often seen in women between the ages of 25 and 35.

Cervical dysplasia is caused by a common virus called human papilloma virus, or HPV. HPV is a sexually transmitted virus. There are hundreds of strains of HPV; some are low-risk and cause genital warts, and others are high-risk and cause cell changes that can turn into cervical dysplasia and cancer.

According to the Journal of the American Medical Association (JAMA), an estimated 26.8 percent of women tested positive for one or more strains of HPV. (Dunne, et al., 2007)

There are several risk factors for cervical dysplasia, some of them directly related to the risk of HPV:

• having an illness that suppresses the immune system or being on immunosuppressant drugs
• having multiple sexual partners
• giving birth before the age of 16
• having sex before the age of 18
• smoking cigarettes

If you are sexually active, a condom might reduce your risk of getting HPV, but the virus can still live on the skin surrounding the genitals not covered by the condom.

There are typically no symptoms of cervical dysplasia. Occasionally abnormal bleeding may occur. However, in the absence of symptoms, the cell changes are invisible to the naked eye and are usually found during a regular Pap smear.

Pap smear results will indicate a squamous intraepithelial lesion, or SIL. This indicates cellular tissue damage or dysplasia.

There are different categories of SIL, including:

• low-grade SIL, or LSIL
• high-grade SIL, or HSIL
• possibility of cancer
• atypical glandular cells (AGUS)

Many times, LSIL goes away on its own. Your doctor might recommend a follow-up Pap smear in several months to monitor the cell changes. If your doctor is concerned or you have high-grade changes, a colposcopy may be done.

A colposcopy is an in-office procedure that allows the doctor to get a very close view of your cervix. A vinegar solution is applied to the cervix and a special light is used; this will make any abnormal cells stand out. The doctor can then take a small piece of cervical tissue (biopsy) to send to a lab for further testing.

If a biopsy shows dysplasia, it is then classified as cervical intraepithelial neoplasia (CIN). There are three categories of CIN:

• CIN I, mild dysplasia
• CIN II, moderate dysplasia
• CIN III, severe dysplasia or carcinoma in situ

Carcinoma in situ is cancer that has not spread below the surface layer.

Treatment of cervical dysplasia depends on the severity of the condition. Mild dysplasia might not be treated immediately since it can resolve without treatment. Repeat Pap smears may be done every three to six months. For CIN II or III, treatment can include:

• cryosurgery, which freezes abnormal cells
• laser therapy
• loop electrosurgical excision procedure, or LEEP, using electricity to remove affected tissue
• cone biopsy, when a cone-shaped piece of the cervix is removed where the abnormal tissue is

Dysplasia is usually caught early because of regular Pap smears. Treatment typically cures cervical dysplasia, but it can return. If no treatment is given, the dysplasia may get worse, potentially turning into cancer.

The only definite way to prevent cervical dysplasia is by practicing abstinence. However, there are things you can do to reduce your risk of getting HPV and cervical dysplasia:

• Practice safer sex by using a condom.
• Consider the HPV vaccine if you are between the ages of 9 and 26.
• Avoid smoking cigarettes.
• Wait to have sex until you are at least 18 years old.
• Avoid multiple sexual partners.

Talk with your doctor about your sexual activity and ways that you can take steps to lower your risk of cervical dysplasia.