What is dysplasia?
Dysplasia is a lesion of the cervix characterised by the presence of abnormal and benign cells, which are sometimes high-risk depending on the grade. While they do not all present the same risk of development, dysplasia can develop if not detected or treated.
What causes dysplasia?
The long-suspected influence of sexual factors (early age of onset of sexual activity, multiple partners) has been confirmed by the implication of certain strains of papillomavirus called HPV. However, an individual with a steady partner can also be exposed to the virus.
Indeed, recent studies have established that an infection by this virus is associated with almost all cases of advanced dysplasia, with the development process sometimes occurring years after viral contamination. However, all women exposed to the virus do not develop dysplasia and usually, thanks to the immune system, they eliminate the virus naturally. There is no clearly defined population at risk: a stable sex life is sufficient to be exposed to the virus. The development of papillomavirus lesions essentially depends on the individual´s tolerance to the virus and adequate or inadequate immunity; women are not equal in the face of HPV. The cancer / infection ratio is estimated at 1 : 20. In any event, the cancer risk only concerns women who are not screened. Those who are monitored, and treated where necessary, run no risk.
Are there clear symptoms?
At the dysplasia stage, a cervical lesion gives no symptoms. This is precisely what makes this menace so insidious. Pain, bleeding (other than menstrual) whether spontaneous or following sex, and vaginal discharges are late - but characteristic - signs of pre-cancer or cancer of the cervix. Hence the importance of screening.
In the event of an abnormality, what is the strategy?
Where a smear reveals an abnormality, it needs to be supplemented by a colposcopy which allows the “transformation zone”of the cervix to be examined and a sample to be taken, if an abnormality is found.
Depending on the type of abnormality and its size, the treatment may be local destruction (laser vaporisation, cryotherapy etc.) or surgical destruction (conisation). It is reassuring to bear in mind that the resection of the transformation zone of the cervix does not compromise any future pregnancy.
Where the smear is ASCUS, colposcopy should be suggested only if the HPV test is positive.
What does the follow-up consist of?
In theory, the destruction of the lesion wipes out any risk of development. Gynaecological monitoring will simply be done to check the absence of any recurrence. This follow-up may comprise a smear or an HPV test. Colposcopy is the reference examination allowing any recurrence of the lesion to be ruled out.
Can the disease be prevented?
The availability of a vaccine raises real hopes of protection against the disease. Given before the onset of sexual activity, the HPV vaccination generates antibodies that act at a very early stage on those HPV strains also contained in the vaccine, neutralising and eliminating them as they reach the surface of the cervix. Vaccines are regarded as a supplementary preventive method to screening.