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What exactly is
ASCUS, LSIL or CIN?
What does that mean for me?

A ASCUS, LSIL or CIN1 is a mild abnormality or in other, more scientific or medical words, a pre-cancerous lesion, with great emphasis on "pre-”cancerous. It is not cancer and the likelihood of it becoming cancer is very low! That's why many people use the following comparison: It is a type of common cold, but not pneumonia that requires hospital treatment.

ASCUS stands for: Atypical Squamous Cells of Undetermined Significance LSIL stands for Low grade Squamous Intraepithelial Lesion Both terms are used when a cervical smear was the basis of the diagnosis.

CIN1 stands for Cervical Intraepithelial Neoplasia grade 1 and is used if a biopsy was taken.
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Cancer or no cancer?
A preliminary stage means that altered cells have been found on the cervix. A LSIL/CIN1 means that mild cell changes have been detected. For ASCUS the cell changes are even milder, between healthy and mild. However, no cancer cells are present! The altered cells could have been caused by an infection with a virus or triggered by a specific virus, the human papilloma virus, or HPV for short.
LSIL/CIN1 is the switch point at which it either goes in one direction or the other – i.e. LSIL/CIN1 regresses and the woman becomes healthy again all by herself or whether it progresses and ends in disease.
Frequently asked questions
Everything you need to know (about ASCUS/LSIL/CIN1)!
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Development

In most women, this pre-cancerous stage heals on its own within 1 – 2 years without anything having to be done. In most cases the immune system is fighting successfully against disease. Only in very few women (approx. 5 percent) does the precancerous stage progress slowly and eventually become cancer, typically about 10 years later.

What to do?

By detecting the capsid protein L1, every woman can find out whether her ASCUS/LSIL/CIN1 will disappear on its own or not: simply, quickly and reliably! Scientifically confirmed by many studies.

L1 - what is that?

The L1 capsid protein is a so-called prognostic protein, i.e. it predicts the further course of the cell changes with a high degree of probability.

How do I prove L1?

L1 is detected on a smear test or a biopsy. The gynecologist can request the L1 test from the laboratory by referral and the health insurance company will cover the costs, in most countries worldwide.

I have the L1 - what now?

Great! Now you can wait and drink tea. Your immune system is defending itself against the altered cells. Promote your immune system by living healthy; reduce smoking or drinking alcohol if relevant in your life style. However, as a kind of watchful waiting, you should still visit your gynecologist every 3-6 months for a smear test.

I don't have an L1 - what now?

Too bad. Your immune system has not recognized the threat and is not doing anything about it. Talk to your gynecologist about what measures should be taken now. A retesting should be considered to see if 3-6 month later the L1 situation has changed.

When does it become cancer?

On average, it takes between 5 and 10 years for a ASCUS/LSIL/CIN1 to develop into cancer. So plenty of time to take the right steps – and no acute danger that should tempt you to make hasty decisions that you may regret one day.

When to have a cone?

Conization should be considered, as the immune system is not activated by the missing L1. The earlier, the better, as this prevents the altered cells from spreading further.

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Info on HPV
No cervical cancer without HPV! HPV stands for “human papillomavirus”. There are hundreds of types of this virus. Low-risk types cause genital warts, for example. High-risk types of HPV are responsible for changes in the cervix, including cancer. The most common high-risk types are 16, 18, 31 and 33.
The most common transmission route for HPV is sexual intercourse. The virus can also be transmitted during oral sex. The virus is transmitted through mucosal contact, but – according to current knowledge – not through saliva, or blood!

If a smear is abnormal, an HPV test is carried out to determine whether it was caused by human papillomavirus. The types are also determined; often the high-risk types 16 and 18, but there are others. Unfortunately, determining the HPV type does not indicate whether the altered cells will regress on their own or not.

An HPV infection, even with so-called high-risk types, only very rarely leads to cancer, even with a ASCUS/LSIL/CIN1! Whether a pre-cancerous stage actually develops into cancer essentially depends on whether the immune system successfully fights against the virus.
HPV negative? An infection with HPV is a prerequisite for the development of cancer of the cervix. If the virus cannot be detected in the ASCUS/LSIL/CIN1, the development of cancer is practically ruled out. Nevertheless, check-ups with a gynecologist should not be neglected to rule out a false negative HPV test!

Various vaccines against HPV are available, but they only work optimally if they are administered before the first sexual intercourse. You can find more information here: https://www.who.int/news-room/fact-sheets/detail/cervical-cancer

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01. The Smear
When the cell smear is taken during the gynecologist's check-up, it is sent to a laboratory for assessment. There, the smear is assessed under a microscope and classified into different categories, as normal (NIL = no intraepithelial lesion) or abnormal as ASCUS, LSIL, HSIL or ASC-H
(https://en.wikipedia.org/wiki/Bethesda_system)
PAP cytological findings
0 Insufficient cell smear
I Inconspicuous findings, normal cell count
II inflammatory or degenerative changes
III Severe inflammatory or degenerative changes, HPV infection is possible
III D mild to moderate cell dysplasia
IVa severe cell dysplasia
IVb Carcinoma in situ possible
V Cervical cancer (cervical carcinoma)
02. What does CIN mean?

If not only a cell smear is taken with a brush, but also a tissue sample (biopsy), which reveals abnormal findings, this is classified as CIN (for Cervical Intraepithelial Neoplasia). These are also precursors of cervical cancer.

A distinction is made between three stages:
CIN I describes a mild cell change in the cervix, similar to LSIL.

CIN II describes a moderate cell change, similar to HSIL.

CIN III describes a severe cell change. In this case, there is a high probability of a transition to cervical cancer. For this reason, conization is often recommended for CIN III.

Who pays the costs for the L1 analysis?

The gynecologist can request the L1 test from the laboratory by referral, the health insurance company covers the costs for the L1 test in most countries worldwide.

References to the studies on L1 capsid protein:

  1. E. Y. Ki et al. 2019, Utility of human papillomavirus L1 capsid protein and HPV test as prognostic markers for cervical intraepithelial neoplasia 2+ in women with persistent ASCUS /LSIL cervical cytology, Int J Med Sci
  2. G. Mehlhorn et al. 2013, HPV L1 detection discriminates cervical precancer from transient HPV infection: a prospective international multicenter study. Nature-Modern Pathology
  3. H. Griesser et al. 2009, HPV vaccine protein L1 predicts disease outcome of high-risk HPV+ early dysplastic lesions. Am J Clin Pathol
  4. R. Hilfrich, J. Hariri, 2008. Prognostic relevance of HPV L1 capsid protein detection within mild to moderate dysplastic lesions of the cervix uteri in combination with a second biomarker p16. Anal Quant Cytol Histl
  5. H. Griesser et al. 2004. Correlation of immunochemical detection of HPV L1 capsid protein in pap smears with regression of high-risk HPV positive mild/moderate dysplasia. Anal Quant Cytol Histol
Do you have questions on the topic or would you like to request information material?
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