Cervical intraepithelial neoplasia (CIN); Precancerous changes of the cervix

Less than 5% of all Pap smear test results find cervical dysplasia. While the cause is unknown, a number of risk factors have been identified. Most cases occur in women aged 25 to 35.

Other risk factors include:

• Multiple sexual partners
• Starting sexual activity before age 18
• Having children before age 16
• DES exposure
• Having had sexually transmitted diseases, especially HPV (genital warts) or HIV infection

There are usually no symptoms.

A pelvic examination is usually normal.

The following tests may indicate cervical dysplasia:

• Pap smear showing mild, moderate, marked, or severe dysplasia.
• Colposcopy revealing "white epithelium." These are mosaic-like patterns on the surface of the cervix, caused by changes in the surface blood vessels.
• Colposcopy-directed biopsy to confirm dysplasia and the extent of cervical involvement.
• Endocervical curettage to rule out involvement of the cervical canal.
• Cone biopsy may be necessary to rule out invasive cancer.

The treatment depends on the degree of dysplasia. Mild dysplasia, which may go away on its own, usually involves careful observation with repeat Pap smears every 3 to 6 months. Other forms may require methods to destroy the abnormal tissue, including electrocauterization, cryosurgery, laser vaporization, or surgical removal.

Consistent follow-up, every 3 to 6 months or as prescribed, is essential.

Nearly all cervical dysplasia can be cured with early identification, proper evaluation and treatment, and careful, consistent follow-up.

Without treatment, 30-50% cases of cervical dysplasia may progress to invasive cancer. The risk of cancer is higher for severe dysplasia (CIN III) that is not treated.

The condition may return.

Call for an appointment with your health care provider if you are a woman who is sexually active or aged 20 or older, and you have never had a pelvic examination and Pap smear.

Call for an appointment with your health care provider if you have not had regular Pap smears at these intervals:

• 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 DES daughters (women whose mothers took DES during the pregnancy)
• The frequency recommended by your health care provider after an abnormal Pap smear or prior dysplasia

To reduce the chance of developing cervical dysplasia:

• Wait until you are 18 or older before becoming sexually active
• Practice monogamy and use condoms during intercourse

Wright TC Jr, Cox JT, Massad LS, Twiggs LB, Wilkinson EJ; ASCCP-Sponsored Consensus Conference. 2001 Consensus Guidelines for the management of women with cervical cytological abnormalities. JAMA. 2002 Apr 24;287(16):2120-9. Review.

Hoffman MS, Martino MA. 2001 consensus guidelines for the management of women with cervical intraepithelial neoplasia. Am J Obstet Gynecol. 2004 Sep;191(3):1049