The term "dysplasia" is used to describe abnormal changes in the cells found on the surface of the cervix. Dysplasia may occur in three stages, mild, moderate and severe. By definition, mild dysplasia involves 25% of the thickness of the cell layer overlying the cervix. Moderate dysplasia involves 50% of the cell layer. When severe dysplasia is diagnosed, the abnormal cells involve almost the full thickness of the cell layer.
Cancerous cells are the most severe of the abnormal cells found on Pap tests. Carcinoma in situ involves the full thickness of the surface cells of the cervix. Invasive cancer of the cervix means the disease has progressed beyond the surface layer of cells.
What causes dysplasia?
Dysplasia is caused by the human papillomavirus (HPV). HPV is sexually transmitted. It has been discovered that approximately 60% of sexually active college students acquire HPV at some point during college. HPV can cause genital warts, but fewer than 5% of women infected with the HPV will develop genital warts. HPV can penetrate the cells of the cervix even if a woman has never had genital warts. The virus causes abnormal cell development on the cervix called dysplasia. Recent studies show that HPV can spontaneously disappear with time. Dysplasia can also spontaneously resolve with time. Women under the age of 24 tend to get over the infection and subsequent dysplasia quicker than older women. Smoking has been associated with an increased risk of the progression of dysplasia to cervical carcinoma.
Is dysplasia a serious risk to my health?
In most cases mild dysplasia will spontaneously revert to normal without treatment over a period of several years. A younger woman with dysplasia has a greater chance of regression, i.e. return to normal state. In a few instances it will progress slowly to more advanced stages. In rare instances, dysplasia may progress to cervical cancer.
Do I need immediate treatment for mild dysplasia or moderate dysplasia?
Since mild dysplasia often returns to normal without therapy, immediate treatment is seldom needed or recommended. Even moderate dysplasia can resolve spontaneously in women age 25 or younger.
How should I follow up after a biopsy shows dysplasia?
It turns out follow-up depends on your age and what your Pap smear showed prior to your biopsy. Sometimes mild dysplasia is preceded by a Pap smear showing atypical squamous cells of undetermined significance (ASC-US), or a low grade squamous intraepithelial lesion (LGSIL). For women up to the age of 24 who had one of these findings on pap and who now have mild dysplasia on biopsy, a repeat Pap smear every year until two normal paps are achieved is adequate. For women over 25 and over with one of these paps and mild dysplasia on biopsy, it is recommended to repeat a pap and HPV test in one year. If the pap and HPV test are negative in one year, routine screening is recommended.
Other times, mild dysplasia is preceded by a Pap smear showing atypical squamous cells cannot rule out a high grade lesion (ASC-H) or a high grade squamous intraepithelial lesion (HGSIL). For women with these findings up to the age of 24, the mild dysplasia on biopsy is followed by a Pap smear and colposcopy every 6 months for one year. If the results are negative at both visits, the patient can return to routine annual screening. For women over 25 with one of these two readings on pap, a repeat pap and HPV test in one and two years are recommended. Women with mild dysplasia on biopsy and a pap showing atypical glandular cells (AGC) at any age should also repeat their pap and HPV test in one and two years.
Women with moderate dysplasia under the age of 25 can be followed every six months with pap smears and colposcopy. If moderate dysplasia persists for two years or if severe dysplasia develops, treatment can be performed. Women over age 25 with moderate dysplasia who wish to decrease their risk of preterm delivery following treatment can follow this same plan. Women who do not plan future pregnancies or who are not worried about preterm delivery may treat moderate dysplasia without waiting.
Severe dysplasia is treated at any age.
Women are encouraged to discuss any concerns or questions regarding follow-up recommendations with their physician.
How can I help my body recover from this condition more quickly?
If you smoke cigarettes, stop! Smoking depresses the immune system that is responsible for the healing process. Eating a healthy diet, limiting alcohol intake and getting 6-8 hours of sleep a night may also help boost the immune system. Consistent use of condoms lessens the risk of further exposure to HPV and protects the cervix from further irritation.
To schedule an appointment, call 333-2700 and select Women’s Health.
ReferencesHo, G.Y., et al. Natural History of Cervicovaginal Papilloma Virus Infection in Young Women. New England Journal of Medicine 338 (7): 423-428, 1998
Moscicki, Anna-Barbara, et. Al. Rate of and Risks for Regression of Cervical Intraepithelial Neoplasia 2 in Adolescents and Young Women. Obstet Gyn 116 (6): 1373-1380, 2010.
Massad, L.S., et al. 2012 Updated Consensus Guidelines for the Management of Abnormal Cervical Cancer Screening Tests and Cancer Precursors. Journal of Lower Genital Tract Disease, Vol 17, Number 5, 2013, S1-S27.