Cervical Dysplasia

Menstuff® has compiled the following information on Cervical Dysplasia.

 

What is cervical dysplasia?

When a female goes to a clinic or her health care provider for a Pap smear, they are screening the cells on her cervix to make sure that there are no abnormal or precancerous changes. If the Pap test results show these cell changes, this is usually called cervical dysplasia. Other common terms the health care provider may use include:

All of these terms mean similar things - it simply means that abnormalities were found. Most of the time, these cell changes are due to HPV. There are many types of HPV that can cause cervical dysplasia. Most of these types are considered "high-risk" types, which means that they have been linked with cervical cancer.

How can a person get the types of HPV that cause cell changes?

When and how do I screen for cervical cancer?

According to the American Cancer Society, a female should get her first screening by age 21, or within three years of becoming sexually active - which ever happens first.

Many women are used to getting screened once a year. However, newer research has found that it is not necessary to screen this often, especially if newer tests are being used. So now you and your health care provider have a few options available on screening methods.

See the sections below for more information on these tests.

Even though screening for cervical cancer can occur less often, it is still important for you to see your health care provider annually for other female-related health care needs - ask your provider what they recommend.

How do I prepare for a Pap or HPV test?

Try to schedule the test on a day when you do not expect to be on your menstrual period. If your period begins unexpectedly and will be continuing on the day of your test, try to reschedule the appointment.

Testing/Diagnosis

What about abnormal Pap test results?

The term "abnormal Pap" is broad and not very specific. There are many different systems that health care providers use to classify a Pap test. Within each system, there are different degrees of severity or abnormalities. The various classification systems and degrees of severity include:

Women with abnormal Pap test results are usually examined further for cervical problems. This may involve coming back for a colposcopy and biopsy, or coming back in a few months for another Pap test. If the Pap result is “ASC-US,” then a HPV-DNA test may be done in the lab to see whether HPV is causing this borderline “normal-abnormal” Pap result.

What's the difference between a Pap test, a biopsy and a HPV test?

A Pap test, or Pap smear, is a screening to find abnormal cell changes on the cervix (cervical dysplasia) before they ever have a chance to turn into cancer. During a pelvic exam, a small brush or cotton tipped applicator will be used to take a swab of cervical cells. These cells are then put either on a glass slide or in a container with liquid, and sent to the laboratory for evaluation. The most common commercially available liquid-based Pap test is called ThinPrep®, manufactured by Cytyc.

A biopsy is similar to a Pap test, but a larger cluster of cells is removed from the cervix to see if there are abnormal cell changes. It is a good way to confirm the earlier Pap smear result and to rule out cancer. If a biopsy is done, it will be performed at the same time as the colposcopy.

An HPV test is different than a Pap test or biopsy. This test checks directly for the genetic material (DNA) of HPV within cells, and can detect the "high-risk" types connected with cervical cancer. The test is done in a laboratory, usually with the same cell sample taken during the Pap test. The only commercially available test for HPV is called Hybrid Capture II™, produced by Digene. It is most convenient if the HPV test is done in the laboratory from a cervical cell sample that was taken using a liquid-based Pap test.

When is a HPV test used?

Currently, the HPV test called Hybrid Capture II™, is approved by the U.S. Food and Drug Administration (FDA) for use in two different situations:

(1) As a follow-up test if the Pap result is borderline between "normal" and "abnormal." This is usually called "atypical squamous cells" or "ASC-US." The HPV test is then used in the lab to determine if women with the borderline result are more likely to have precancerous changes on their cervix, (HPV positive), and which are more likely to just have normal cells (HPV negative). Basically, the test helps to rule out whether HPV is causing the borderline abnormal cells.

(2) As a cervical cancer screening test in combination with a Pap test in women at or over age 30 (rather than just having the Pap test alone). Research shows that the combination test can increase the effectiveness of detecting any problems early on. A preliminary recommendation by the American Cancer Society state that if the combination Pap - HPV DNA test (Digene’s DNA with Pap™ test) result is normal/negative, then the next screening would not have to be for three years. However, if one of the tests in the DNA with Pap comes back abnormal/positive, then follow-up will be needed.

When is a HPV test NOT used?

Can a male find out if he has the cell changing-types of HPV?

Research has shown that the HPV test may lead to inconsistent results with men. This is because it is difficult to get a good cell sample to test from the thick skin on the penis. Most people will not have visible symptoms if they are exposed to HPV. Therefore, for most, the virus is subclinical (invisible). This is especially true for males. If a male is exposed to the cell-changing types of HPV, he would be unlikely to have symptoms. If there are no symptoms for males, it is hard to test for it. Most of the time, men will not have any health risks such as cancer with the "high-risk" types of HPV. It is the female's cervix that needs to be monitored.

Treatment

There are a variety of treatments for cervical dysplasia:

What about HPV and pregnancy?

What about HPV and other cancers?

Anal dysplasia and anal cancer:

Penile Intraepithelial Neoplasia (PIN) and penile cancer:

Vaginal Intraepithelial Neoplasia (VAIN) and vaginal cancer:

Vulvar Intraepithelial Neoplasia (VIN) and vulvar cancer:

Is it normal to feel upset about HPV?

Yes, it is normal. Some people feel very upset. They may feel ashamed, fearful, confused, less attractive or less interested in sex. They feel angry at their sex partner(s), even though it is usually not possible to know exactly when or from whom the virus was spread. Some people are afraid that they will get cancer, or that they will never be able to find a sexual partner again. It is normal to have all, some or none of these feelings. It may take some time, but it is important to know that it is still possible to have a normal, healthy life, even with HPV. Ways to help cope with HPV emotionally:

Reduce your risk

Any one who is sexually active can come across this common virus. Ways to reduce the risk are:

Source: www.ashastd.org/hpv/hpv_learn_dysplasia.cfm

Surveillance a Better Option for Young Women at Risk for Cervical Cancer


Cervical Cancer Risk May Linger

Treatments that remove abnormal cervical lesions before they can turn into cancer save lives, but they may also lead to complications during pregnancy, a review of the research shows.

Women who had the procedures also had an increased risk for several adverse pregnancy outcomes, including giving birth to preterm or low-birth weight babies and needing C-section.

Researchers who reviewed 27 studies examining the most widely used treatments for removing abnormal cervical cells concluded that they are associated with a "small but real increase" in the risk of pregnancy-related problems.

They further concluded that close surveillance may be a better option than treatment for young women because young women have a very low risk of developing cervical cancer.

"The current vogue (in favor of treatment) has clearly been shown to have long-term adverse obstetric outcomes, and delay in treatment would avoid these unnecessary outcomes in a substantial proportion of women younger than 25 years," researcher Maria Kyrgiou, MD, and colleagues from London's Royal Preston Hospital wrote in the Feb. 11 issue of The Lancet.

Concerns About Overtreatment

Cervical cancer deaths in the U.S. have dropped by almost 50% since the 1970s, thanks to increased screening using the Pap test.

During a routine Pap smear, cervical cells are sampled and sent to the lab to look for cell changes or abnormalities that might be cancerous or become cancerous.

But there have been increasing concerns that universal testing has resulted in overtreatment of suspicious lesions, especially among very young women who have a low risk of developing cervical cancer.

In 70% to 90% of cases, mild cellular abnormalities in young women go away on their own without treatment, American Cancer Society gynecologic cancer expert Debbie Saslow, PhD, tells WebMD.

This is why the ACS has come out against the aggressive treatment of young women with mildly abnormal Pap results, she says.

"Less than one in 100,000 women will get cervical cancer before the age of 25," she says. "That isn't zero, but it is a very low risk."

Knife, Laser, or Loop

The newly published analysis examined obstetric outcomes in women who had abnormal cervical cells removed by either:

"The outcomes for LLETZ are especially important," wrote Kyrgiou and colleagues, "because it is now by far the most popular treatment for [removing precancerous cells]."

There were fewer adverse events with the laser conization procedure, and no significant increase in risk was seen with laser ablation.

While the findings seem to favor laser ablation for minimizing obstetric risk, Saslow says the other procedures may have advantages in other areas.

"There are pros and cons with all of these procedures, and a physician may have other reasons for performing one over another," she says.
Sources: Kyrgiou, M. The Lancet, Feb. 11, 2006; vol 367: pp 489-498. Maria Kyrgiou, MD, department of obstetrics and gynecology, Queen Charlotte's and Chelsea Hospital, Hammersmith Hospitals, London. Debbie Saslow, PhD, director of breast and gynecologic cancers, American Cancer Society. www.webmd.com/content/Article/118/113046.htm

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