Progression to cervical cancer happens slowly

By Ann Pietrangelo 

Published on July 27, 2023

 Medically reviewed by Cordelia Nwankwo, MD

Cervical dysplasia is not cervical cancer. It's a condition in which you have abnormal cells on the surface of your cervix, known as cervical intraepithelial neoplasia (CIN). Because it has some potential to develop into cancer, it's often called a precancer.

Each year, 250,000 to 1 million people get cervical dysplasia.¹ Different grades of cervical dysplasia range from mild to severe. While it can progress from one grade to another, that's not always the case.

This article discusses what you should know about cervical dysplasia treatment and the risk of developing cervical cancer.

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Cervical Dysplasia: A Precursor, Not Actual Cancer

Cervical cancer is when abnormal cervical cells reproduce and spread in an uncontrolled way.² Cancer cells can invade nearby tissue and form tumors. They can also enter the lymph system or bloodstream to reach other body parts.

Cervical dysplasia is considered a precancer because some cells are abnormal compared to healthy cells, but these cells are not invasive.

Cervical dysplasia can clear up on its own and never cause a problem. But the more abnormal the cells are, the more likely they become cancerous. Most people treated for precancerous conditions of the cervix don't develop cervical cancer.³

Cervical Dysplasia Grades

If your Pap test result is negative (normal), the test didn't detect any cell changes on the cervix. An unclear, equivocal, or inconclusive result means there may be abnormal changes. You might need to take another test to clarify. An abnormal result means the test detected abnormal cells on the cervix.

A pathology report following cervical biopsy (taking a sample of tissue for examinaiton in the lab) shows cervical dysplasia grades as follows:

• CIN 1 (mild dysplasia): Some cells on the surface of the cervix are slightly abnormal, but it's not cancer. Though it can develop into cancer, it usually resolves without treatment.⁴ It's also called low-grade squamous intraepithelial lesion (LSIL).

• CIN 2 (moderate dysplasia): Some cells are moderately abnormal but not cancerous. Without treatment, it has the potential to develop into cancer and spread to nearby tissue.⁵

• CIN 3 (severe dysplasia): Some cells are severely abnormal. Severe dysplasia is serious, but it's still not cancer. However, it can become cancerous if not treated.⁶ It's also called high-grade squamous intraepithelial lesion (HSIL).

How Quickly Does Cervical Dysplasia Progress?

Cervical changes happen slowly, and cervical dysplasia doesn't always progress. It's also possible to have CIN 3 (high grade) even if you didn't have CIN 1 (low grade).⁷

A more significant factor in progression may be persistent human papillomavirus (HPV) infection. HPV doesn't always cause cervical cancer. But it does cause almost all cases of cervical dysplasia.¹

The immune system can usually take care of the short-term infection that causes low-grade changes to cervical cells. High-grade changes from long-lasting infections are more likely to become cancer without treatment. Factors that may promote longer-term infection are:⁸

• Having a weakened immune system

• Infection with human immunodeficiency virus (HIV)

• Smoking

Chronic stress may also be an independent risk factor for high-risk HPV in young women.⁹

If you have a healthy immune system, cervical cancer can take 15 to 20 years to develop. If you have a weakened immune system, it may take five to 10 years.² Healthcare professionals can't be sure which cases will progress and which won't.

Treatment: What Do Providers Do for Cervical Dysplasia?

If you have abnormal test results, the next step is usually a colposcopy.

Colposcopy is a procedure that lets your provider examine the cervix. Like a regular pelvic exam, your provider will use a speculum to open the vagina. Then they'll apply a vinegar solution to highlight abnormal areas. A colposcope (a thin instrument with a light and magnifying lens) allows a good view of the cervix. They'll remove a sample of the abnormal tissue and send it to a lab.¹⁰

If the cervical biopsy shows precancerous changes, your healthcare provider will make a recommendation based on factors such as grade, medical history, and overall health. Treatment involves removing or destroying abnormal cells. Some treatment options include:¹¹¹

• Loop electrosurgical excision procedure (LEEP): This can occur in your provider's office in just a few minutes. You only need local anesthesia. LEEP uses an electrified wire loop to remove abnormal tissue.

• Cold knife conization (cold knife biopsy): This outpatient procedure requires general anesthesia. Your provider uses a scalpel or laser knife to remove a cone-shaped piece of the cervix, along with the abnormal tissue.

• Cryotherapy: It doesn't require anesthesia and only takes a few minutes. The gynecologist uses a cold probe to freeze and destroy the abnormal tissue.

• Laser therapy: Performed in a hospital under general anesthesia, it uses intense light to destroy abnormal tissue.

You may have bleeding and other discharge during the first two to three weeks after your procedure. You might also experience discomfort or minor cramping. Your provider may recommend avoiding intercourse and tampons for four to six weeks.¹²

Because CIN 1 often goes away on its own, your provider may not recommend immediate treatment. You'll likely need follow-up testing in six to 12 months.⁴

Many people find a pelvic exam with a speculum uncomfortable or even painful. Anxiety before the exam is not uncommon.¹³ If you've had problems, tell your provider so they can help make the procedure as comfortable as possible. Here are a few ways to help make the exam easier:

• Ask your provider to talk you through the exam.

• Bring someone who can hold your hand and distract you.

• Practice deep breathing during the exam.

• Concentrate on muscle relaxation.

• Use earbuds to listen to soothing music.

When to Have Another Pap for Cervical Dysplasia

Cervical dysplasia can return, particularly if you have an ongoing HPV infection. Your provider will likely suggest a schedule for follow-up testing. This may include HPV testing or HPV/Pap co-testing in one to three years. Much depends on the grade from your previous test and personal risk factors for severe cervical cell changes and cervical cancer.¹²

Cervical cancer screening can help prevent you from getting cervical cancer.

You can't feel cervical dysplasia. Most people have no symptoms of HPV or cervical dysplasia until it develops into cancer. Getting regular Pap and HPV tests is the best way to find it.¹

 Vaginal Intraepithelial Neoplasia (VaIN): Low- and High-Grade Results

Summary 

Cervical dysplasia means you have abnormal cells on the surface of your cervix. It's not cancer. Cervical dysplasia can be mild, moderate, or severe. Mild dysplasia often clears up without treatment.

But it's considered a precancer because it has the potential to become invasive. Your provider may recommend treatment for moderate to severe dysplasia. This may involve removing or destroying the abnormal cells. With treatment, most cases of cervical dysplasia don't progress to cancer. Finding and treating abnormal cells can help prevent cervical cancer from developing.