Dysplasia is abnormal cell growth that can potentially lead to cervical cancer if left untreated. LEEP (loop electrosurgical excision procedure) is a common treatment used to remove these precancerous cells from the cervix. A frequent concern after having a LEEP is whether the dysplasia will come back. Here is an overview of the likelihood of recurrence and steps you can take to lower your risk.
What is dysplasia and how is it treated?
Cervical dysplasia refers to precancerous changes in the cells on the surface of the cervix. It is caused by persistent infection with human papillomavirus (HPV). HPV is a very common sexually transmitted infection that often causes no symptoms.
There are three grades of dysplasia that reflect increasing severity:
- Mild dysplasia (CIN 1)
- Moderate dysplasia (CIN 2)
- Severe dysplasia and carcinoma in situ (CIN 3)
Over time, untreated high-grade dysplasia (CIN 2 or 3) can progress to cervical cancer. However, it often takes years or decades for cancer to develop. Treating dysplasia is important to prevent this progression.
The most common treatment for both lower grade and higher grade dysplasia is loop electrosurgical excision procedure (LEEP). This is done by applying an electrified wire loop to the cervix to burn away the abnormal cells. It only takes about 10-15 minutes and can usually be done in your doctor’s office.
LEEP has high success rates for completely removing dysplasia. One advantage of LEEP over other treatments like cone biopsy is that it results in less injury to the cervix.
What is the likelihood of recurrence after LEEP?
Unfortunately, it is possible for dysplasia to return after having a LEEP. Recurrence rates depend on several factors:
1. Severity of original dysplasia
Women who originally had higher grade dysplasia are more likely to have it return compared to those with milder dysplasia:
- For CIN 1, the recurrence rate is about 10-15%
- For CIN 2, the recurrence rate is 15-30%
- For CIN 3, the recurrence rate is 25-50%
2. Completeness of LEEP excision
When abnormal tissue extends to the outer edges of the specimen removed during LEEP, this signals that some dysplasia was likely left behind. This incomplete excision increases the risk of recurrence.
3. Age at time of treatment
Younger women under 30 appear to have higher recurrence rates after LEEP compared to older women. This may be related to greater HPV activity in younger patients.
4. HPV status
Persistence of high-risk HPV genotypes like HPV 16 and 18 is strongly linked to recurrence of dysplasia. HPV testing should be part of follow-up after LEEP treatment.
Here is a table summarizing how these factors impact recurrence rates:
| Risk Factor | Recurrence Rate |
|---|---|
| Mild dysplasia (CIN 1) | 10-15% |
| Moderate dysplasia (CIN 2) | 15-30% |
| Severe dysplasia (CIN 3) | 25-50% |
| Incomplete LEEP excision | 50% or higher |
| Age under 30 | 30-40% |
| Positive HPV 16/18 | 35-60% |
When does recurrence happen after LEEP?
Most cases of recurrence happen within the first 2 years after LEEP. However, dysplasia can still return many years later. One study found the risk remains elevated for at least 5 years after treatment before going back down to the levels of someone who has never had dysplasia.
That’s why long-term surveillance with co-testing (Pap test and HPV test) is recommended. Most guidelines say to have follow-up testing every 6 months for the first year, then annually for the next several years.
Can recurrent dysplasia be treated?
Yes, there are several good treatment options if dysplasia does recur after initial treatment with LEEP:
- Repeat LEEP – If the recurrence is localized to a small area, another excisional procedure may successfully remove it.
- Cone biopsy – This procedure removes a cone-shaped piece of tissue from the cervix. It may be used for more extensive disease.
- Hysterectomy – Removal of the uterus and cervix may be recommended, especially for women who do not want more children.
- Topical treatments – Medications like imiquimod or fluorouracil cream applied directly to the cervix have some effectiveness for mild dysplasia.
The good news is that the cure rate with these treatments remains high – 75-90% of women will have no further recurrences. But continued surveillance is still needed.
What can reduce the risk of recurrence?
There are a few key things women can do to lower their risk of having dysplasia return after LEEP:
1. Quit smoking
Tobacco use is associated with a significantly higher risk of recurrence after cervical dysplasia treatment. Quitting smoking right away is one of the best things you can do.
2. Treat any HPV infection
Since HPV causes dysplasia, having an active infection increases the chances it will return. Discuss treatment options with your doctor, especially if you test positive for high-risk HPV strains.
3. Get regular screenings
Follow-up with co-testing every 6-12 months in the first 1-2 years allows early detection and treatment if dysplasia does recur.
4. Consider HPV vaccination
The Gardasil vaccine protects against the HPV strains most linked to cervical cancer. It may help prevent reinfection if you have not completed vaccination.
5. Practice safer sex
Using condoms reduces exposure to HPV that could reactivate infection and lead to recurrent dysplasia.
What is the long-term outlook after LEEP?
With close monitoring and proper follow-up care, most women who have LEEP for cervical dysplasia go on to have normal Pap test results. In one large study, 85% of women treated for high-grade dysplasia had no evidence of recurrence 3 years later.
However, even after dysplasia resolves, it’s important to continue lifelong surveillance with Pap testing. The risk of developing precancer or cancer in the future remains somewhat higher than the general population. But with screening, the outlook for early detection and normal life expectancy is good.
Conclusion
Recurrence of dysplasia after LEEP treatment is common, especially for women with higher grade disease. Close follow-up in the first 1-2 years is imperative to catch any recurrent abnormalities early. Quitting smoking, treating HPV, getting fully vaccinated, and practicing safe sex can all help lower recurrence risk. While dysplasia can return and require further treatment, the prognosis for healthy outcomes remains very positive with appropriate screening and follow-up care.