Cervical dysplasia refers to the abnormal growth of cells on the cervix. The abnormal cells are classified into low-grade or high-grade lesions. The Pap smear test was designed to assess for cervical dysplasia, also known as cervical intraepithelial neoplasia. The American Congress of Obstetricians and Gynecologists reports that cervical cancer incidence has fallen 50 percent in the last 30 years in the United States due to broad use of the Pap smear. If abnormal cells are detected by a Pap smear, the tissue may be removed by the loop electrosurgical excision procedure, or LEEP.
Causes
In 2006, the Centers for Disease Control and Prevention reported that 11,982 women in the United States were diagnosed with cervical cancer, and 3,976 women died from the disease. Approximately 70 percent of cervical cancers are caused by chronic infection by human papillomavirus subtypes 16 and 18. In 2006, the Food and Drug Administration approved Gardasil, a vaccine against human papillomaviruses 16 and 18, for the prevention of cervical cancer. The FDA reported Gardasil is nearly 100 percent effective in preventing precancerous cervical lesions caused by human papillomaviruses 16 and 18. The American Cancer Society states that the other risk factors for cervical cancer are smoking, HIV infection, chlamydia infection, dietary factors, long-term use of birth control pills, multiple pregnancies, exposure to diethylstilbestrol and a family history of cervical cancer.
Procedure
During the LEEP, a physician inserts a speculum into the vagina and then removes the abnormal cervical tissue using a wire loop in which an electrical current passes through. A colposcope magnifies the cervix during the surgical procedure to allow the physician to distinguish between abnormal and normal tissue. Local anesthesia is used in the LEEP.
Side Effects and Complications
After the LEEP, light bleeding, pain, itching, discharge and discomfort may be present for several days. A review study in "BioMed Central Women's Health" reported that 1.2 percent of women who had LEEP had an infection requiring antibiotic treatment. The 2006 consensus guidelines published in the October 2007 issue of the "American Journal of Obstetrics and Gynecology" reported that women who have had the LEEP procedure have a small risk of having preterm delivery and infants with a low birth weight.
Effectiveness
A 2001 study in the "American Journal of Obstetrics and Gynecology" reported that after LEEP, cervical dysplasia reoccurs on average in 31 percent of women. A 2008 study published in the "International Journal of Gynaecology and Obstetrics" reported the LEEP cured 93 percent of low-grade lesions and 72 to 85 percent of high-grade lesions. This study also reported that the cure rate was influenced by the size of the lesion.
Follow-up
The 2006 consensus guidelines published in the "American Journal of Obstetrics and Gynecology" recommend that women who have had cervical dysplasia should receive screening for abnormal cells every 6 to 12 months. Additionally, every 12 months women should be tested for recurrent infection by human papillomavirus.
References
- The American Congress of Obstetricians and Gynecologists: First Cervical Cancer Screening Delayed Until Age 21 Less Frequent Pap Tests Recommended
- Center for Disease Control: Cervical Cancer Statistics
- American Cancer Society: Overview: Cervical Cancer
- The Food and Drug Administration: Gardasil (Human Papillomavirus Vaccine) Questions and Answers
- "BioMed Central Women's Health": Are Treatments for Cervical Precancerous Lesions in less-developed Countries Safe
