Management of cervical dysplasia

Abstract

Abnormal cervical screening tests are diagnosed in millions of women each year in the United States. In some, the abnormality is indicative of cervical dysplasia or even invasive cervical cancer. The work-up of an abnormal cervical screening test includes colposcopy and cervical biopsies. Based on those results, treatment for cervical dysplasia can consist of observation or intervention with an excisional biopsy. In deciding to intervene aggressively, one must consider special circumstances including patient age, desire for future fertility, and concurrent pregnancy. Understanding the role human papillomavirus (HPV) plays in cancer development has led to advancements in detection and treatment of cervical dysplasia. Both preventative and therapeutic vaccinations against HPV provide promise in decreasing the number of women affected by this disease. This chapter highlights key changes in the recent ASCCP guidelines including the importance of conservative management among younger women as well as recommendations on the proper utilization of HPV cotesting. The rationale for HPV vaccination is also discussed.