Cervical intraepithelial neoplasia (CIN); Cervical dysplasia
Cervical dysplasia is the abnormal growth of the epithelial tissue on the surface of the cervix. It refers to a spectrum or continuum of changes specified as: CIN I - mild dysplasia; CIN II - moderate to marked dysplasia; and CIN III - severe dysplasia to carcinoma-in-situ (cancer localized to the intraepithelial tissue/superficial layer of the cervix).
Causes, incidence, and risk factors
While the cause is unknown, a number of predisposing factors have been identified. Less than 5% of all Pap smear tests conducted note Cervical dysplasia. It may occur in women aged 15 and older, with most cases in women aged 25 to 35.
Increased risk is associated with: multiple sexual partners, early onset of sexual activity (at less than age 18), early childbearing (at less than age 16), and past medical history of DES exposure or sexually transmitted diseases, especially HPV (genital warts) or HIV infection.
There are usually no symptoms.
Signs and tests
A pelvic examination is usually normal.
- A Pap smear shows mild, moderate, marked, or severe dysplasia.
- A colposcopy reveals “white epithelium” or mosaic-like patterns on the cervical surface, which are caused by changes in the surface capillaries.
- A colposcopy-directed biopsy confirms dysplasia and the extent of cervical involvement.
- An endocervical curettage should be done to rule out involvement of the cervical canal.
- A cone biopsy may be necessary to rule out invasive cancer.
The treatment of Cervical dysplasia depends on the degree of dysplasia. Treatments range from careful observation with repeat Pap smears every 3 to 6 months for mild dysplasia (which may regress on its own), to methods used to eradicate the abnormal tissue, including: electrocauterization, cryosurgery, laser vaporization, or surgical removal.
Consistent follow-up, every 3 to 6 months or as prescribed, is essential.
With early identification, adequate evaluation; treatment; and careful, consistent, follow-up; nearly all Cervical dysplasia can be cured. Without treatment, 30-50% cases of Cervical dysplasia may progress to invasive cancer.
The condition may recur.
Calling your health care provider
Call for an appointment with your health care provider if you are a woman who is sexually active, or are aged 20 or older, and have had no prior pelvic examination and Pap smear.
Call for an appointment with your health care provider if a subsequent Pap smear has not been obtained at recommended intervals of:
- Every year initially
- For women up to age 35 or 40: every 2-3 years after having three negative, consecutive annual Pap smear tests and a single sexual partner or no sexual partner
- Every year for women over age 35 or 40
- Every year for women who have had multiple sexual partners
- Every year for women who are taking oral contraceptives (birth control pills)
- Every 6 months for women who have a history of HPV (genital warts)
- Every year for women who were prenatally exposed to DES
- The frequency recommended by your health care provider after an abnormal Pap smear or prior dysplasia
Deferring sexual activity until age 18 or older, practicing monogamy, and safer sex behaviors all reduce the potential of developing Cervical dysplasia.
by Levon Ter-Markosyan, D.M.D.