LEEP (loop electrosurgical excision procedure) is a treatment for precancerous cervical lesions and early stage cervical cancers. It involves using an electrically charged wire loop to remove abnormal precancerous cells from the cervix. While LEEP is highly effective at removing these abnormal cells, there is a chance that precancerous cells can come back after the procedure.
What is LEEP?
LEEP is a common treatment for cervical dysplasia, which refers to precancerous changes in the cells of the cervix. During LEEP, a thin wire loop electrode is used to remove the abnormal cells from the cervix. The procedure usually takes less than 30 minutes and can be performed in a doctor’s office or clinic.
LEEP has several advantages:
- It is highly effective at removing abnormal cervical cells that could become cancerous if left untreated.
- It preserves the patient’s ability to carry a pregnancy in the future.
- Recovery time is quick – most women can resume normal activities within a day or two.
- It does not require general anesthesia.
- It avoids the risks, longer recovery, and higher costs of more extensive surgery.
For these reasons, LEEP has become the standard treatment for most cases of precancerous cervical dysplasia.
Why precancerous cells may come back after LEEP
While LEEP is highly successful at removing visible precancerous tissue from the cervix, there are a few reasons why abnormal cells may return after the procedure:
- The margins were not clear – If the lab analysis finds that precancerous cells extended to the edge of the tissue removed during LEEP, this means some abnormal cells may have been left behind.
- The abnormal cells were deeper – LEEP can only remove tissue from the surface of the cervix. Deeper precancerous cells may remain.
- HPV infection remains – HPV, or human papillomavirus, is responsible for causing precancerous changes in cervical cells. If the patient’s HPV infection persists after LEEP, it can cause new precancerous lesions.
- Cervical scarring develops – LEEP can cause scarring on the cervix. This scar tissue is more prone to developing new precancerous changes.
Even when LEEP successfully removes all visible precancerous tissue from the cervix, there is still a chance that abnormal cells microscopically remain and eventually grow into new precancerous lesions. For this reason, patients treated with LEEP require long-term surveillance with repeat cervical cancer screening.
Recurrence rates: How often do precancerous cells return after LEEP?
Several large studies have looked at how often cervical dysplasia recurs after LEEP treatment. The recurrence rates from these studies are summarized below:
| Study | Recurrence Rate |
|---|---|
| ALTS Trial, 2003 | 10.7% recurrence within 2 years |
| Ghaem-Maghami et al., 2007 | 28.8% recurrence within 16 months |
| Serati et al., 2009 | 11.4% recurrence within 2 years |
| Martin-Hirsch et al., 2013 | 16% recurrence within 12 months |
In summary, recurrence rates in these studies ranged from about 11-29% within the first 1-2 years after LEEP. The risk appears highest in the first year after LEEP and gradually declines over time.
Risk factors for recurrence
Many factors can influence a woman’s risk of recurrence after LEEP:
- Positive LEEP margins – Women with precancerous cells at the edge of their LEEP specimen have a 2-5 times higher risk of recurrence.
- Higher grade dysplasia – Moderate or severe dysplasia (CIN 2/3) is more likely to recur than mild dysplasia.
- Glandular cell involvement – Glandular precancerous lesions have higher recurrence rates.
- HPV infection – Women who test positive for high-risk HPV after LEEP are more likely to have recurrent disease.
- Immune status – Women with weakened immune systems have a higher risk of recurrence.
- Younger age – Younger women, under 30-35, have higher chances of new HPV infection and lesion development.
- History of previous dysplasia – Women with recurrent episodes of cervical dysplasia before LEEP are more prone to recurrence.
- Exposure to smoking – Cigarette smoking increases recurrence risk.
Identifying these risk factors can help determine which women need closer surveillance after LEEP.
Follow-up recommendations after LEEP
Due to the risk of recurrence, women need long-term surveillance with repeat cervical cancer screening after being treated with LEEP. Follow-up guidelines recommend:
- Pap test every 6 months for 2 years after LEEP.
- HPV testing at 6 months and 12 months post-LEEP. Women who test positive for HPV should have a repeat LEEP.
- Annual Pap and HPV co-testing for at least 20 years after the initial abnormal Pap result, even if LEEP margins were clear.
More frequent Pap tests may be recommended for women at higher risk of recurrence. The Pap tests will screen for any residual or recurrent precancerous cells. HPV testing looks for the presence of the virus that causes these cell changes.
Some experts recommend repeat LEEP if Pap or HPV results remain abnormal one year after the initial LEEP. The need for repeat LEEP also depends on the amount of dysplasia found in the original LEEP specimen.
Can recurrent precancerous cells after LEEP become cancer?
Yes, if precancerous cells recur after LEEP and are not treated, they can worsen over time and potentially develop into cervical cancer. During the years after LEEP, any recurrent dysplasia has a chance to progress:
- Mild dysplasia (CIN 1) progresses to cancer in 1% of cases.
- Moderate dysplasia (CIN 2) progresses to cancer in 5% of cases.
- Severe dysplasia (CIN 3) progresses to cancer in 12% of cases.
This demonstrates why close surveillance in the years after LEEP is so important – to detect and treat any recurrent lesions before they have a chance to become cancer.
The good news is that when caught and treated early, the cure rate for recurrent precancerous cells remains high, just as it was with the original dysplasia. This is why following post-LEEP monitoring guidelines is critical.
Does LEEP cure precancerous cells?
While LEEP is very effective at removing visible precancerous tissue, it cannot guarantee a permanent “cure” for two reasons:
- Possibility of residual cells – Despite the best efforts of the surgeon, microscopic abnormal cells may be left behind after LEEP.
- Risk of new lesions – LEEP does not protect against getting new HPV infections in the future, which could cause new precancerous lesions to form.
However, when women adhere to close follow-up with Pap/HPV co-testing after LEEP, the chances of detecting and treating any residual or recurrent dysplasia remains excellent.
While not a guarantee against any future recurrence, LEEP provides the best opportunity to:
- Remove existing precancerous tissue from the cervix.
- Allow close surveillance for early detection of any persistent or new lesions.
- Prevent progression to cervical cancer.
When combined with long-term compliance with Pap and HPV screening, LEEP is very effective at controlling precancerous cervical changes.
Can LEEP cure early stage cervical cancer?
In some cases, LEEP may be used to treat very early stage cervical cancers, in place of more extensive surgery. This includes stage IA1 cervical cancer, which is limited to the surface layer of cervical tissue and less than 3mm in depth of invasion.
Several studies have found similar cure rates when comparing LEEP to hysterectomy for IA1 cervical cancer:
| Study | LEEP Cure Rate | Hysterectomy Cure Rate |
|---|---|---|
| Biliatis et al., 1992 | 100% | 100% |
| Eduardo et al., 2002 | 91% | 100% |
| Cambou et al., 2013 | 91-96% | 98-99% |
Based on this data, LEEP appears nearly equivalent to hysterectomy for treating IA1 cervical cancers. Like its use for precancerous lesions, LEEP allows a fertility-sparing and less invasive surgical approach.
However, not all experts agree that LEEP alone is sufficient for IA1 cancer treatment. Many still recommend a hysterectomy to fully stage the cancer and ensure adequate margins. Talk to your doctor about the best treatment options for your individual cancer stage and needs.
The takeaway
While not perfect, LEEP remains the most effective and conservative treatment option for precancerous cervical dysplasia. When combined with long-term surveillance and screening, it provides an excellent chance to remove abnormal tissue and prevent cervical cancer from developing.
However, due to the risk of residual or recurrent disease, follow-up with Pap and HPV testing at regular intervals is absolutely essential after LEEP. Committing to this monitoring will allow new lesions to be detected early and retreated.
Catching and treating any recurrent precancerous cells before they have a chance to progress prevents cancer and preserves fertility for women treated initially with LEEP. While not a guarantee against any future recurrence, LEEP offers the best opportunity for long-term cervical health.