Cervical Dysplasia Follow-Up

Content provided by the Faculty of the Harvard Medical School

Cervical Dysplasia Follow-Up

Question:

I am 53 and still have periods, although they are irregular. My doctor diagnosed cervical dysplasia after a Pap smear. Further tests indicated it was not HPV. She did a colposcopy and said everything looked good. I had a follow up exam at five months and the status was the same. I will have another six-month exam this week. What happens if I still get an abnormal Pap smear? Do I have to have a LEEP procedure? When do we take action?

Answer:

The Pap smear is a screening test for cervical dysplasia, a precancerous condition of the cervix. The ability to detect and treat dysplasia has dramatically decreased the incidence of cervical cancer and is an important success story for medical screening.

Pap smears identify abnormal cervical cells. A range of abnormalities occur. Milder forms called atypia. There are also low-grade lesions and high-grade lesions. The more severe the abnormality, the higher the risk that the cells could progress to cancer. However, Pap smears alone are not accurate enough to make the diagnosis and guide treatment. A significant finding on a Pap smear is followed up with a colposcopy in which a magnifying scope is used to evaluate the cervix.

Atypia and low-grade dysplasia often just go away or end spontaneously. It is appropriate to follow patients with these changes for about one year before undertaking treatment. Treatments, including the removal of abnormal cells by a LEEP procedure, are quite successful, but carry a small risk of cervical injury and should not be performed unless necessary. High-grade changes are less likely to go away. They have a significant risk of getting worse, so they are treated right away.

Joan Bengtson, M.D., is assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and a member of the Department of Obstetrics, Gynecology & Reproduction at Brigham and Women's Hospital.

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Last updated:	July 20, 2009

Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.

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