The Loop Electrosurgical Excision Procedure (LEEP) is an effective treatment for precancerous changes on the cervix. It uses a thin, heated wire loop to remove abnormal cells, often detected through Pap tests or colposcopy. This procedure prevents these cells, known as cervical dysplasia, from progressing to cervical cancer. LEEP is highly successful, with reported cure rates ranging from 73% to 99%.
Recurrence After LEEP
While LEEP is generally very effective, precancerous cells can sometimes return. Some studies indicate that around 4% of people may experience a recurrence within five years. Approximately 3.2% of individuals required further treatment for recurrent cervical dysplasia one year after their LEEP. This shows that while LEEP is successful for most, recurrence is a possibility.
Reasons for Recurrence
Several factors contribute to the potential return of precancerous cells after LEEP. The most common underlying cause is the persistence of human papillomavirus (HPV) infection, which initially led to the abnormal cell growth. LEEP removes affected cells but does not eliminate the HPV infection itself. If the HPV infection remains, it can lead to new precancerous changes.
Incomplete removal of affected tissue during the initial LEEP procedure is another reason for recurrence. This is often indicated by “positive margins,” meaning that abnormal cells were found at the edges of the removed tissue sample. While LEEP aims to remove all abnormal cells, sometimes microscopic portions may remain. Even with negative margins, HPV persistence can still lead to recurrence. A new HPV infection with a different strain after the procedure can also cause new precancerous changes to develop.
Ongoing Monitoring
Consistent monitoring is necessary after a LEEP procedure to detect any potential recurrence of precancerous cells. Regular follow-up appointments are scheduled to ensure treatment effectiveness and to identify any new abnormalities early. These follow-up visits typically involve Pap tests, which check for abnormal cervical cells, and HPV tests, which detect the presence of the virus. This ongoing surveillance allows for timely intervention if precancerous cells return.
A common follow-up schedule might include a Pap test and HPV test every 6 to 12 months for the first two years after LEEP. If results remain normal, routine screenings may then revert to every three to five years. In some cases, a colposcopy, a closer examination of the cervix, may also be performed during follow-up if test results are abnormal.
Treatment for Recurrence
If precancerous cells are detected again after an initial LEEP, several treatment options are available. The specific approach depends on the severity and location of the new abnormal cells. A repeat LEEP procedure is often a viable option, especially if the recurrence is similar to the initial finding.
Another treatment method is a cone biopsy, also known as a cold knife conization. This procedure removes a larger, cone-shaped section of tissue from the cervix, often used for more precise excision or if previous LEEP margins were positive. Other methods, such as laser ablation, which destroys abnormal cells with a laser, may also be considered.
Steps to Reduce Risk
Individuals can take several steps to reduce their risk of precancerous cells returning after LEEP. HPV vaccination protects against types of HPV that cause cervical cancer. Practicing safe sex, including consistent condom use, can reduce the risk of acquiring new HPV infections, though condoms do not offer complete protection. Avoiding smoking is another important step, as it significantly increases cervical cancer risk and impairs the body’s ability to clear HPV. Maintaining overall health and attending all recommended follow-up appointments are also essential for long-term management and early detection.