Cancer Cervix
Cancer Cervix
Cancer Cervix
day [11]. In the UK, an estimated 7% of cervical cancers titers have been observed for at least 8.4 years for the bi-
are linked to tobacco smoking [12]. High parity, smoking, valent vaccine with 100% seropositivity, and for at least
nutrition and use of combined hormonal oral contracep- 8 years for the quadrivalent vaccine [16, 17]. High effi-
tives for more than 5 years have been reported as major cacy against HPV 16 and 18 infection and CIN 3 lesions
environmental risk factors for cervical cancer in various was reported in two phase III pre-licensure trials among
studies [13, 14]. Infection with other sexually transmitted HPV-naïve vaccine recipients with the quadrivalent vac-
diseases such as HIV, herpes, chlamydia, gonorrhea and cine [16, 18]. High efficacy with bivalent vaccine against
availability of human resources, it may be used as a single- mended. Alternatively, combined HPV and cytology test-
round or multiple-round screening approach as demon- ing may be repeated again within 12 months. The screen-
strated in the two RCTs. ing guidelines remain the same for women who have
received the HPV vaccine. Women at high risk for cervi-
cal cancer may need to be screened more often.
Recommendations for Cervical Cancer Screening These recommendations of cervical cancer screening
are not applicable to less developed regions of the world
The current recommendations for cervical cancer where various logistics and feasibility challenges exist.
screening by different societies from the more developed Due to the high cost of setting up cytology-based screen-
countries, i.e. the American Cancer Society (ACS) [41], ing programs, screening coverage is very low in low- and
the American Society for Colposcopy and Cervical Pa- middle-income countries including India and hence, al-
thology (ASCCP) [41], the American Society of Clinical ternative screening methods need to be explored [44]. The
Pathology (ASCP) [41], the United States Preventive Ser- alternative methods of cervix cancer screening like the
vices Task Force (USPSTF) [42] and the American Con- VIA alone or triage of VIA-positive women with cytology
gress of Obstetrics and Gynecologist (ACOG) [43], for appear promising. In the western world, the standard
the general population are similar. It has been recom- practice for cervical cancer screening is to screen women
mended that screening for cervical cancers with Pap using cytology (Pap test) and refer the cytology-positive
smears is to be initiated at 21 years and continued every women for colposcopy and biopsy of the suspicious le-
3 years between the ages of 21–29 years. Thereafter, be- sions. The diagnosis of CIN is based on histological con-
tween the ages of 30 and 65 years, screening can be con- firmation and accordingly the subsequent treatment is
ducted every 5 years if cotesting with Pap smear is done planned. Though this strategy has been highly successful
or every 3 years if Pap smear screening alone is used. in reducing mortality in excess of 50% in many developed
There is no need to screen women older than 65 years un- countries, it requires highly trained human resources and
less there was a diagnosis of cervical pre-cancer. Similar- a substantial amount of laboratory equipment.
ly, screening is not recommended for women that have The ‘screen-and-treat’ approach is an alternative meth-
undergone hysterectomies for a benign cause and who do od in which the treatment decision is based on the results
not have prior history of cervical cytology higher than of the screening test or strategy (sequence of tests or triage
CIN2. For women who test negative on Pap smear but for those with a positive first screening test result) and not
positive on HPV test, genotyping of HPV 16/18 and col- on a histologically confirmed diagnosis of CIN 2+ unless
poscopy only for women with positive results is recom- an invasive cancer is suspected. Either of the tests, i.e.
References
1 Ferlay J, Soerjomataram I, Ervik M, Dikshit R, 4 IARC: Human papillomaviruses; in: Biologi- 7 WHO: Weekly Epidemiological Record. Ge-
Eser S, Mathers C, Rebelo M, Parkin DM, For- cal Agents: A Review of Human Carcinogens. neva, 2014, No. 43, vol 89, pp 465–492. http://
man D, Bray F: GLOBOCAN 2012 v1.0. Cancer IARC Monographs on the Evaluation of Car- www.who.int/wer/2014/wer8943/en/ (ac-
Incidence and Mortality Worldwide: IARC cinogenic Risks to Humans. Lyon, IARC, cessed October 20, 2014).
Cancer Base No. 11. Lyon, IARC, 2013. http:// 2012, vol 100B. http://monographs.iarc.fr/ 8 Denny LA, Francheschi S, de Sanjosé S, Heard
globocan.iarc.fr (accessed November 28, 2014). ENG/Monographs/vol100B/mono100B-11. I, et al: Human papillomavirus, human im-
2 WHO Guidance Note: Comprehensive Cer- pdf (accessed September 2014). munodeficiency virus and immunosuppres-
vical Cancer Prevention and Control: A 5 Clifford G, Franceschi S, Diaz M, Muñoz N, sion. Vaccine 2012;30S:F168–F174.
Healthier Future for Girls and Women. Villa LL: Chapter 3: HPV type-distribution in 9 Harper DM, Demars LR: Primary strategies
WHO, 2013, p 2. women with and without cervical neoplastic for HPV infection and cervical cancer preven-
3 Bruni L, Diaz M, Castellsagué X, Ferrer E, diseases. Vaccine 2006;24(suppl 3):S3/26–34. tion. Clin Obstet Gynecol 2014;57:256–278.
Bosch FX, de Sanjosé S: Cervical human pap- 6 Insinga RP, Dasbach EJ, Elbasha EH, Liaw K, 10 IARC: List of Classifications by Cancer Sites
illomavirus prevalence in 5 continents: meta- Barr E: Progression and regression of incident with Sufficient or Limited Evidence in Hu-
analysis of 1 million women with normal cy- cervical HPV 6, 11, 16 and 18 infections in mans, vol 1–105.
tological findings. J Infect Dis 2010;202:1789– young women. Infect Agent Cancer 2007; 2:
1799. 15.