For many people, the word «precancer» alone sounds alarming and is closely associated with cancer. However, such a diagnosis often points to the possibility of preventing cancer from developing — not its inevitability, according to Ilya Fomintsev, an oncologist and project manager for the International Partnership for Oncology Residencies in Kazakhstan (IPSM).
What is a precancerous condition?
As the oncologist explains, a precancerous condition is not cancer.
«A precancerous condition is a state in which cells have already changed and begun to behave abnormally, but haven’t yet acquired the defining characteristic of cancer — the ability to invade surrounding tissue and spread. Simply put, it’s not a fire, but overheating wiring. The house isn’t burning yet, but ignoring it would be foolish,» the doctor explained.
Does precancer always progress to cancer?
«No — and what’s crucial here is that a precancerous condition doesn’t mean cancer is inevitable. It simply means the risk is higher than it would be for someone without these changes,» the expert emphasized.
Some changes may resolve on their own. For example, mild cervical dysplasia in young women often clears up without treatment. However, other conditions require closer monitoring and more active treatment.
Which precancerous conditions are considered the most dangerous?
Conditions that significantly raise the risk of developing cancer — or that can be difficult to treat if caught late — require particularly close attention.
The expert recommends taking the following conditions seriously:
- CIN 2–3 / HSIL of the cervix
- Adenomatous and serrated colon polyps, especially large, multiple, or villous ones, or those with high-grade dysplasia
- Barrett’s esophagus with dysplasia
- Atypical endometrial hyperplasia
- Leukoplakia and erythroplakia of the oral mucosa, especially in smokers
- Actinic keratosis and Bowen’s disease of the skin
- Gastric dysplasia, especially when associated with atrophic gastritis, intestinal metaplasia, or H. pylori infection
- Mucinous cystic lesions of the pancreas with high-risk features
«The key isn’t the label ‘precancer’ — it’s the specifics: where it was found, what degree of dysplasia is present, whether it’s confirmed by solid pathology, whether the lesion was fully removed and what follow-up schedule is needed,» the doctor explained.
Can progression be stopped?
The good news is that many precancerous conditions are highly treatable.
«In fact, that’s exactly what we work toward. Precancer is one of the few situations in oncology where we can step in before cancer ever develops. A polyp can be removed during a colonoscopy. CIN 2-3 can be treated locally. Dysplasia associated with Barrett’s esophagus can sometimes be removed or ablated endoscopically. H. pylori can be eradicated, lowering the risk of further changes. With actinic keratosis, you can treat the skin and cut down on UV exposure,» Fomintsev said.
According to the expert, changes may completely regress in some cases, while in others they may be removed or the risk of further progression significantly reduced.
What to do if you’re diagnosed with a precancerous condition
The most important thing, according to the doctor, is to avoid going to extremes.
«First, don’t panic. Second, don’t ignore it. Both are the wrong move,» he explains.
He recommends five straightforward steps:
- Make sure you fully understand your diagnosis. What exactly does it say — what grade of dysplasia, what stage of CIN, what type of polyp or hyperplasia and is atypia present?
- Verify the pathology. A true precancer diagnosis is typically made not by visual inspection alone, but through a biopsy or removed tissue. If slides or tissue blocks are available, consider having them reviewed by a pathologist.
- See the right specialist. For cervical issues, see a gynecologist; for intestinal concerns, a gastroenterologist or endoscopist; for skin, a dermatologist or oncodermatologist; for esophageal or stomach issues, a gastroenterologist; and for endometrial concerns, a gynecologist.
- Get a concrete plan — treatment, removal, or surveillance. A good doctor’s answer shouldn’t just be «we’ll watch it.» You should leave with specifics: what’s being done, when, by what method and what the follow-up looks like in months or years.
- Understand your risk factors. Smoking, HPV, H. pylori, UV exposure, obesity, chronic inflammation and alcohol aren’t just generic «healthy lifestyle» talking points — they are real, documented factors that directly affect risk in many precancerous conditions.
«The bottom line is this: a precancerous condition is not cancer. Cancer hasn’t happened yet. And if everything is handled correctly, there’s a very good chance it never will,» Fomintsev said.
