I have not had a normal Pap in three years. I have had four colposcopies. After the first one (moderate dysplasia CIN-2), my doctor performed a conization, but I still have abnormal cells and my latest colposcopy showed mild dysplasia. I am very concerned. Should I have other tests done, see a specialist or visit my doctor more than every six months? What is the prognosis for persistent dysplasia?

--Kristine

If you are concerned and are questioning the recommendations of your doctor, then by all means see a specialist -- a gynecologic oncologist would be the most appropriate choice. Dysplasia may persist if the original abnormal area was incompletely removed or treated.

Dysplasia may also recur if you have been infected with the sexually transmitted human papilloma virus (HPV). HPV is almost impossible to eradicate from the body and may continue to infect new cervical cells; this is especially true of the more aggressive HPV subtypes such as 16, 18 and 31. If you have been told you have HPV, ask your doctor about doing HPV subtype testing. This simple (though expensive) test can determine if you have one of the HPV subtypes that are more often associated with cervical cancer. If you do, you need to be followed more closely and treated more aggressively.

For a lower-risk subtype, it may be appropriate to follow up with Pap smears only. In the lower-risk groups, over half the cases of mild dysplasia will revert to normal without any treatment at all. For this reason, we often do not treat mild dysplasia. Pap smears are usually done every four to six months after diagnosis of or treatment for dysplasia.