The basic diagnostic tool for cervical dysplasia is the Pap test, a procedure that removes a small sample of cervical cells. A lab then analyzes the sample to determine if there are any abnormal cells (ACOG 2013c).
When results of a Pap test are abnormal, this does not mean that the patient has cancer, but rather that further evaluation is needed. Mildly abnormal cells sometimes may go away on their own. Additional tests after an abnormal Pap test may include a repeat Pap test, or a more detailed examination called colposcopy, which uses a low-power microscope to examine the cervix, and which is capable of viewing abnormalities that cannot be seen by the naked eye (Weppner 2014). During colposcopy, the doctor may sometimes also perform a biopsy. If precancerous changes are present, treatment will be based on several factors, such as age, the exact type of abnormal results, or how long abnormal cells have been present (ACOG 2013c; Brookner 1997). It is important that healthcare practitioners distinguish cervical dysplasia from other conditions that may present similarly, such as hyperkeratosis, metaplasia, warts, glandular epithelial abnormalities, and some types of cancer (Weppner 2014).
Cervical Screening Exams
Cervical cancer screening can detect changes in cervical cells that may lead to cancer. Screening includes the Pap test and, for some women, testing for HPV. The latest routine cervical cancer screening guidelines, released by the American Congress of Obstetricians and Gynecologists in 2013, read as follows (ACOG 2013b):
- Cervical cancer screening should start at age 21 years; women and girls younger than this need not be screened.
- Women aged 21–29 years should have a Pap test every three years.
- Women aged 30–65 years should have a Pap test and an HPV test every five years. It is acceptable to have a Pap test alone every three years.
- Women should no longer have cervical cancer screening after age 65, unless they have a history of moderate or severe dysplasia or cancer. If they have such history but have had either three negative Pap test results in a row, or two negative HPV and Pap co-test results in a row within the past 10 years, with the most recent test performed within the past five years, they need not resume screening. Once screening is stopped after age 65, it should not be resumed.
- Women who have a history of cervical cancer, are infected with HIV, have a weakened immune system, or were exposed to DES before birth should not follow these routine guidelines. In these cases, women should seek guidance from their healthcare provider.
- If a woman has an abnormal cervical cancer screening test result, additional testing or treatment may be indicated. Her healthcare provider will recommend when she can return to routine screening.
- For women aged 30–65 years, the combination of a Pap test plus an HPV test can help predict whether dysplasia will be diagnosed in the next few years, even if the Pap test results are normal. If the results of both the HPV and Pap tests are normal, the chance that mild or moderate dysplasia will develop in the next four to six years is very low.
- If a woman has had a hysterectomy that preserved her cervix, she may still need to undergo cervical cancer screening. Whether a woman needs to continue to have screening tests depends on why the hysterectomy was needed, whether the cervix was removed, and whether she has a history of moderate or severe dysplasia. Women in this situation should consult with their healthcare provider(s).