5 Questions About Cervical Dysplasia to Ask Your Doctor

Receiving abnormal results from a cervical cancer screening test can be scary. Abnormal changes found in the cells of the cervix are called “cervical dysplasia” or “cervical intraepithelial neoplasia” (CIN). While cervical dysplasia isn’t cancer, it has the potential to become cancer. Sometimes cervical dysplasia is called pre-cancer.

Most likely, if you’ve been told you have dysplasia, it was found during cervical cancer screening. Regular screening is the best way to find cervical cancer early. Getting regular screening tests can actually help prevent cervical cancer, too.

“The goal of screening is to identify precancerous changes in the cervix so we can treat it and prevent cervical cancer from developing. What’s different about cervical cancer screening compared to, for example, breast cancer screening, is that for breast cancer screening, we are typically aiming to find the cancer at its earliest point. But in cervical cancer screening, it can actually be detected before it becomes cancerous,” said Eleonora Teplinsky, MD, an American Society of Clinical Oncology (ASCO) expert and head of breast and gynecologic medical oncology at Valley-Mount Sinai Comprehensive Cancer Care.

In some cases, cervical dysplasia will go away on its own and never develop into cancer. But finding it early can help you and your doctor determine the best plan for you. There are different options for follow-up testing, monitoring, and treatment depending on your HPV test results and the type and severity of cervical dysplasia that you have.

Here are 5 important questions to ask if you’ve been told you have cervical dysplasia:

Do I have HPV?

Certain high-risk types of HPV cause almost all cervical pre-cancers and cancers. An HPV test will either be positive (high-risk types are found) or negative (no high-risk types are found). Knowing your HPV test results, how often you need to be tested, and what the results mean are key parts of planning care for cervical dysplasia. Having an HPV infection that persists, or doesn’t go away, can lead to more abnormal changes in cervical cells.

What type of cervical dysplasia do I have?

There are 3 types of cervical dysplasia:

• CIN1 is mild. Most of these cases go away on their own.
• CIN2 is moderate. Many of these cases also go away on their own. However, CIN2 is more likely to become severe dysplasia or develop into cancer.
• CIN3 is severe. CIN3 is more likely than CIN1 and CIN2 to become cancer.

Knowing the type of cervical dysplasia helps your doctor determine whether you need more testing or if treatment might be needed. Your HPV test result will help show if an HPV infection might have caused the dysplasia. When recommending next steps, your doctor will consider all of this information, along with your age, other risk factors, and other health problems you may have.

How likely is it for cervical dysplasia to turn into cancer?

Cervical cell changes usually happen slowly. In fact, it can take many years for a cell change to become cancerous. How a person’s immune system responds to the cell changes and how advanced the cervical dysplasia can affect how fast a dysplasia may become cancer.

For people with CIN1, the majority of cases will never develop into cancer. Many cases of CIN2 will also go away on their own. CIN3 is less likely to go away without treatment and is more likely to develop into cancer.

Is there anything I can do to prevent dysplasia from developing into cancer?

If you haven’t had the HPV vaccine, talk to your doctor. Teens and young adults ages 13 through 26 years who have not been vaccinated or who have not received the full series of shots should get the vaccine as soon as possible. Vaccination of young adults will not prevent as many cancers as vaccination of children and teens. “It’s something that isn’t necessarily going to help in the moment, but if that CIN is removed, it will reduce the chance of it coming back,” said Dr. Teplinsky. The American Cancer Society (ACS) does not recommend HPV vaccination for people older than 26 years.

Monitoring for changes when you have had cervical dysplasia will be part of your care. For CIN1 and some milder CIN2 types, your doctor might recommend continuing to monitor it with regular testing.

For more severe cases of CIN2 and for cases of CIN3, your doctor might recommend treatment. There are 2 main treatment approaches for removing dysplasia:

• Excision. During an excision, the dysplasia is cut out from the cervix. Loop electrosurgical procedure (LEEP) is one type of excision. During this procedure, a thin wire loop is heated with electricity and acts like a knife to remove the abnormal cells. A cold knife biopsy is another type of excision. During this procedure, a laser or scalpel is used to remove the dysplasia.
• Ablation. Ablation destroys the dysplasia using a laser (laser ablation), cold temperatures (cryosurgery), or hot temperatures (thermal ablation).

How will I be monitored for cervical cancer?

No matter what type of dysplasia you have, it’s important to know how you will continue to be monitored for cervical cancer. The frequency of this monitoring will depend on several factors. These include the severity of the dysplasia, your age, and whether you had other abnormal changes in your cervix before the dysplasia. Ask your doctor how often to schedule follow-up appointments to check for cervical cancer.

It’s also important to monitor for changes or new symptoms in between follow-up appointments, such as common symptoms of cervical cancer. Your doctor can talk to you about what to look for and what to do if you notice a new change or symptom.

Dr. Teplinsky is a member of ASCO’s Patient Information Editorial Board.