Cervical Cancer Screening

2018 ◽  
Author(s):  
Huma Farid

Since the Papanicolaou (Pap) smear became implemented as a screening tool for cervical cancer, the mortality from cervical cancer has sharply declined in the United States. The discovery of the human papillomavirus (HPV) as the causative agent in the progression from dysplasia of the cervix to cervical cancer has changed the types of screening offered to women and the management of abnormal Pap smears. The management of abnormal Pap smears has changed depending on the age of the woman, with women under the age of 24 years being managed more conservatively given the low rates of cervical cancer in this age group and the high rates of regression of HPV and cytologic abnormalities. Colposcopy remains the first line in evaluation of an abnormal Pap smear, with excisional treatment reserved for high-grade dysplasias with a high risk of progression to cervical cancer. Treatment for cervical dysplasia is highly effective, but even after treatment, there is an increased risk of recurrence or progression to cervical cancer for up to 20 years, and these women should be followed closely. This review contains 18 figures, 3 tables and 53 references Key words: cervical cancer screening, high-grade cervical dysplasia, human papillomavirus, low-grade cervical dysplasia, management of abnormal Pap smears, Pap smear, recurrence of cervical dysplasia, treatment of dysplasia

2020 ◽  
Author(s):  
Huma Farid

Since the Papanicolaou (Pap) smear became implemented as a screening tool for cervical cancer, the mortality from cervical cancer has sharply declined in the United States. The discovery of the human papillomavirus (HPV) as the causative agent in the progression from dysplasia of the cervix to cervical cancer has changed the types of screening offered to women and the management of abnormal Pap smears. The management of abnormal Pap smears has changed depending on the age of the woman, with women under the age of 24 years being managed more conservatively given the low rates of cervical cancer in this age group and the high rates of regression of HPV and cytologic abnormalities. Colposcopy remains the first line in evaluation of an abnormal Pap smear, with excisional treatment reserved for high-grade dysplasias with a high risk of progression to cervical cancer. Treatment for cervical dysplasia is highly effective, but even after treatment, there is an increased risk of recurrence or progression to cervical cancer for up to 25 years, and these women should be followed closely.  This review contains 18 figures, 3 tables, and 43 references. Key words: cervical cancer screening, high-grade cervical dysplasia, human papillomavirus, low-grade cervical dysplasia, management of abnormal Pap smears, Pap smear, recurrence of cervical dysplasia, treatment of dysplasia


2020 ◽  
Vol 10 (1) ◽  
pp. 1639-1644
Author(s):  
Indrani Krishnappa ◽  
Kalyani R. ◽  
Raja Parthiban ◽  
Abhishek Agrawal

Background: Pap smear examination has been universally used as an effective screening tool for early detection of cervical carcinoma. The aim of this study was to assess the utility of Cervical Acid Phosphatase staining as an adjunct to routine Pap smear testing to improvethe sensitivity and specificity of routine Pap smear examination for cervical cancer detection. Materials and Methods: Cervical smears were taken from patients attending the gynecology department and a few cervical cancer screening programmes. One set of slides were alcohol fixed and stained with rapid pap stain and another set of slides were fixed in a special fixative and stained with Cervical Acid Phosphatase -Pap stain. The nuclear features of these Cervical Acid Phosphatase stained dysplastic cells was studied on Pap stain to diagnose cervical intraepithelial lesion/ malignancy. Results: Out of 489 cases included in the study 6 cases were diagnosed with intraepithelial lesion/ malignancy. On Cervical Acid Phosphatase -Pap stain 2 of the cases diagnosed as inflammatory smears on pap stain showed Cervical Acid Phosphatase positivity and thus were re evaluated. Mild nuclear atypia was observed in the Cervical Acid Phosphatase positive cells and these cases were diagnosed as Low grade squamous intraepithelial lesion and later biopsy proven to be Cervical intraepithelial Neoplasia I. Therefore Cervical Acid Phosphatase -Pap test was 100% sensitive and specific for cervical cancer detection. Conclusions: With 100% sensitivity Cervical Acid Phosphatase -Pap test satisfies the criteria of an efficient screening test.


Biomédica ◽  
2019 ◽  
Vol 39 (1) ◽  
pp. 65-74
Author(s):  
Óscar Gamboa ◽  
Mauricio González ◽  
Jairo Bonilla ◽  
Joaquín Luna ◽  
Raul Murillo ◽  
...  

Introduction: Direct visual inspection for cervical cancer screening remains controversial, whereas colposcopy-biopsy is considered the gold standard for diagnosis of preneoplastic cervical lesions.Objectives: To determine the rates of cervical intraepithelial neoplasia grade 2 or more and of false positives for colposcopy and direct visual inspection.Materials and methods: Women aged 25-59 underwent direct visual inspection with acetic acid (VIA), Lugol’s iodine (VIA-VILI), and colposcopy. Punch biopsies were obtained for all positive tests. Using histology as the gold standard, detection and false positive rates were compared for VIA, VIA-VILI, and colposcopy (two thresholds). Sensitivity and false positive ratios with the corresponding 95% confidence intervals were estimated.Results: We included 5,011 women in the analysis and we obtained 602 biopsies. Positivity rates for colposcopy high-grade and low-grade diagnosis were 1.6% and 10.8%. Positivity rates for VIA and VIA-VILI were 7.4% and 9.9%. VIA showed a significantly lower detection rate than colposcopy with low-grade diagnosis as the threshold (SR=0.72; 95% CI 0.57-0.91), and significantly lower false positive rate (FPR=0.70; 95% CI 0.65-0.76). No differences between VIA-VILI and colposcopy low-grade threshold were observed. VIA and VIA-VILI showed significantly higher detection and false positive rates than colposcopy high-grade threshold. Sensitivity rates for visual inspection decreased with age and false positive rates increased. For all age groups, false positive rates for VIA and VIA-VILI were significantly higher than colposcopy.Conclusions: Detection rates for VIA-VILI similar to colposcopy low-grade threshold represent a chance to reduce cervical cancer mortality through see-and-treat approaches among women with limited access to health care. Lower detection rates suggest reviewing high-grade colposcopy findings as the threshold for biopsy in certain settings.


2011 ◽  
Vol 07 (04) ◽  
pp. 243
Author(s):  
Channa E Schmeink ◽  
Leon FAG Massuger ◽  
Willem JG Melchers ◽  
Ruud LM Bekkers ◽  
◽  
...  

Primary screening based on detection of human papillomavirus (HPV) has proved to be more sensitive than cytology for the detection of high-grade cervical intraepithelial neoplasia (CIN). Self-sampling for specimen collection may also improve the participation rate, especially in the non-responder group. However, HPV is highly prevalent and therefore HPV detection has a lower specificity in cervical cancer screening than cytology. In addition to the clinically validated HPV test, HPV dynamics should be taken into account. It is important to identify women with a chronic productive infection likely to cause, or to already have caused, high-grade CIN or cervical carcinoma, and to limit overtreatment of women with a transient infection. Furthermore, the introduction of the HPV vaccine is likely to lower the incidence of CIN and cervical carcinoma, which will lower the positive predictive value of cervical cancer screening. This potential impact needs to be taken into account when planning for future screening guidelines.


2021 ◽  
Vol 1 (2) ◽  
pp. 55-62
Author(s):  
Nungrutai Saeaib

Objective: To assess the remission rate at postpartum periods of abnormal Pap smears during pregnancy, and to identify the demographic and clinical characteristics of pregnant women with abnormal Pap smears.Material and Methods: Pregnant women, who had antenatal care (ANC) in Songklanagarind Hospital in period of January 2011 to December 2019, were identified retrospectively. Exclusion criteria included inaccessible results of Pap smears during pregnancy and postpartum periods. Medical records of all pregnant women with abnormal Pap smears were reviewed. The association between Pap smear results during pregnancy and postpartum were analyzed by Cramer’s V statistic ranging from 0 to 1, with a 1 indicating perfect association.Results: Of these 8,238 pregnant women had available Pap smear results, 109 (1.3%) women were shown with abnormal results. The most common of abnormality from Pap smears were atypical squamous cells of undetermined significance. In postpartum period, 50 women who had abnormal Pap smear during pregnancy, underwent postpartum follow-up examination at six weeks postpartum, respectively. The majority of results (84.0%) were normal whilst rate of remission occurred in 45 women (90.0%). The association of Pap smears between during pregnancy and postpartum was shown to have a small association (Cramer’s V = 0.2).Conclusion: There was low prevalence of abnormal Pap smear during pregnancy and high remission rate at postpartum. However, health care providers should be aware of cervical cancer screening in all pregnant women, because many women had not undergone cervical cancer screening before pregnancy.


2020 ◽  
Vol 7 (2) ◽  
pp. 239-246
Author(s):  
J. S. Misra ◽  
A. N. Srivastava ◽  
Shivani Singh

Carcinoma cervix is a major health problem faced by Indian women and situation is very alarming in rural population because of illiteracy and poverty. There is urgent need of creating awareness regarding the risk factors of cervical cancer such as early marriage and multiparity in the rural women and the importance of early detection of the cervical cancer. With aim for providing single life time Pap smear cover to the rural women, cervical cancer screening program was initiated in May 2013 by Era's Lucknow, Medical College and Hospital, Lucknow, through organizing camps in the villages of Lucknow ,west. Till December 2019, a total of 183 camps have been organized and 5209 women attended these camps (28.5%). Pap smear examination could be done in only 2912 women (55.9%). The incidence of squamous intraepithelial lesions of cervix (SIL) was found to be very high in these women (17.1%) though majority of SIL were of low grade (LSIL). This may be related to the poor personal genital hygiene prevailing in rural women due to illiteracy. In the present review, the SIL incidence has been extensively analyzed in relation to different predisposing factors of cervical carcinogenesis and problems faced during camp organization and the benefits derived from these camps to rural women have been highlighted.


Sign in / Sign up

Export Citation Format

Share Document