"I was diagnosed with HPV 5 years ago. I then had a colposcopy and biopsy. The results were CIN1/mild dysplasia. I was supposed to go back six months later but was horrified by the pain from the colposcopy and didn’t go back until 5 years later. I thought maybe it had cleared up. I was so wrong. I am going again for another colposcopy on Wednesday because my pap showed the same abnormal cells again.
Does anyone know what CIN1 could have progressed to in 5 years? I really want to know the honest truth. If anyone thinks it could have progressed into cancer, don’t hesitate to tell me. I just have been trying to figure this out and I just can’t figure it out. Whatever it will be it will be. I have since quit smoking cold turkey when I found out I had to get another colposcopy. So those 5 years I smoked and I hope it isn’t too late that I quit. Thanks in advance for any of your support or information."
There is no one size fits all answer to this but let’s give it a try and talk about progression of biopsy proven CIN1 to higher grade lesions and cervical cancer.
Scenario 1: Your initial abnormal Pap smear showed ASCUS or LGSIL (both low grade lesions). If your colposcopy and biopsy showed CIN1 after you had an ASCUS or LGSIL pap aggressive intervention is generally not warranted because a significant number of these lesions spontaneously regress, and progression to CIN 2,3 or invasive cancer is uncommon. That is reassuring and in one large study only 12 to 13 percent of women with HPV positive ASCUS or LSIL PAP smears with a CIN1 biopsy result developed CIN 2,3 over two years. These results lead some to believe that CIN1 is generally a benign process.
Scenario 2: Women with an initial abnormal Pap smear that showed High Grade lesions (HSIL) have a greater than 70 percent prevalence of underlying CIN 2, 3 or worse. So, if you have a cervical biopsy with a CIN1 result after a high grade abnormality on your pap it is managed more aggressively.
Management of the first scenario is debated but most guidelines recommend expectant management of women with biopsy confirmed CIN 1 using follow-up with HPV testing at 12 months or repeat PAP at 6 and 12 months. Follow-up of women with CIN 1 beyond 24 months has shown that spontaneous regression or progression can occur. Close clinical follow-up of a compliant patient with persistent CIN 1, with treatment planned if there is evidence of disease progression or if the women chooses to be treated is a reasonable way to go.
Management of Scenario 2 is a little different. For CIN 1 preceded by high grade abnormalities on a PAP an excisional diagnostic procedure (like a LEEP) has traditionally been recommended. Owing to recent information raising concern over complications after excisional procedures for future pregnancies, such as an incompetent cervix, expectant management is an accepted alternative approach.
If you are a teenager with CIN 1, management is much more conservative. This is because the rate of regression to normal cells is high and the rate of progression to cervical cancer is low. After colposcopy and biopsy if CIN 1, 2 or 3 is confirmed a reasonable approach is to repeat the pap in 6-12 months, if abnormalities persist after 24 months additional therapy is recommended. Again, this is because the procedures done on the cervix at a young age can lead to incompetent cervix and cause problems during pregnancy.
This DS member’s follow up wasn’t ideal but most CIN1 lesions don’t progress to invasive cervical cancer. That said, please see your Doctor for surveillance after an abnormal pap it will give you great reassurance.
- Dr. O
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