DOCSLIB.ORG

Download Article (PDF)

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Download Article (PDF) Bnef reports population, the rate of ASCUS is two to three times the rate of SIL.3 A greater frequency of ASCUS smears may indi­ cate overuse of the diagnosis; however, high-risk populations may have a high­ Management of patients with er incidence. Recent data from several atypical squamous cells of cytopathology laboratories demonstrat­ ed the prevalence of ASCUS to have a undetermined significance (ASCUS) general range of 1.6% to 9.2%; and fol­ low-up of patients with ASCUS smears on Papanicolaou smears showed 10% to 45% with LSIL, less than 7% with HSIL, and less than 1 % RICHARD R. TERRY, DO with cervical cancer.2 Management of patients whose Papanicolaou smears show atypical squamous cells Cytopathologic diagnosis · of undetermined significance (ASCUS) is a complex challenge for the family The term ASCUS is an attempt to classify physician. It is critical that patients with the ASCUS smear be properly evaluat­ cellular changes that are considered nei­ ed and triaged, as the ASCUS smear may be a manifestation of high-grade disease ther reactive nor reparative),? ASCUS in 20% or more of cases. Several options for triage exist. Colposcopy is consid­ encompasses cellular nuclear abnormal­ ered by many the option of choice. However, alternative options include cer­ ities that are not clearly SIL or that owe vicography, speculoscopy, and human papillomavirus subtyping. For proper man­ their existence to inflammatory changes. agement of the patient with the ASCUS smear, the clinician must consider the The precise etiology of the cellular ab­ patient's Pap test history, risk factors for cervical cancer, and the cytopathologist's normalities found in the ASCUS cate­ interpretation/recommendation. gory is not known. Pronounced epithe­ (Key words: Colposcopy, Papanicolaou test, ASCUS [atypical squamous cells lial changes secondary to repair and of undetermined significance], low-grade squamous lesion, high-grade squamous inflammation or nuclear changes associ­ lesion, human papilloma virus subtyping) ated with but not diagnostic of SIL often are classified as ASCUS) In addition, poor sampling or preparation of the Pap he worldwide incidence of cervical on the reporting of minimally abnor­ smear slide may result in an artifact and Tcancer and premalignant cervical mal smears. be misinterpreted as ASCUS. lesions has dramatically increased dur­ The Bethesda System (TBS) of The cytopathologic diagnosis of ing the past quarter century.1 Papani­ cytopathologic reporting developed in ASCUS is based on the following crite­ colaou's (Pap) test has been proved high­ 1988 provided a more concise report ria2,3 (Figures 1 and 2): ly effective as a screening tool for to the clinician than previous classifi­ o nuclear enlargement that is two to prevention of cervical cancer. Histori­ cation systems.2,3 The Bethesda System three times that of a normal squamous cally, several reporting systems have introduced the concept of squamous cell nucleus; been used to describe abnormal cervical intra epithelial lesions (SIL). The previ­ o variation in size and shape; cytology. This multiplicity of reporting ous systems lacked reproducibility; thus, o the possible presence of mild hyper­ systems has led to much confusion a squamous cell lesion under TBS could chromasia; and about management of abnormal Pap be classified as either high-grade (HSIL), o generally smooth nuclear outlines. smears. Previous cytologic systems were low-grade (LSIL), or atypical cells of ASCUS is not synonymous with the clear on the classification of profound­ undetermined significance (ASCUS) previously used terms squamous atypia, ly abnormal Pap smears, but ambiguous under the general category of epithelial inflammatory atypia, or atypical meta­ cell abnormality.4,s plasia. 2 Lesions with abnormalities that Dr Terry is Director, Wilson Osteopathic Family Prac­ do not correspond to the criteria for tice Residency, and Director, Family Practice Obstet­ Prevalence of ASCUS smears ASCUS are considered atypia. In a study rics and Gynecology, Wilson Memorial Hospital, John­ son City, NY. He is also an assistant professor of Some 3% to 10% of women who under­ correlating cytologic criteria and biopsy family medicine, State University of New York Upstate go cervical cytology grading in the Unit­ results, Sidawy and Tabbara8 report that Medical Center, Binghamton , NY; a clinical assistant professor, New York College of Osteopathic Medicine ed States have a cytologic diagnosis of smears designated as "inflammatory of New York Instrtute of Technology, Old Westbury, NY; ASCUS. This prevalence translates into atypia" may be reclassified as either and a clinical assistant professor, Lake Erie College of Osteopathic Medicine, Erie, Pa. approximately 1.5 to 5 million women ASCUS or reparative changes. Their data Correspondence to Richard R. Terry, DO, Direc­ each year. The diagnosis of ASCUS smear suggest that women with Pap smears tor, Wilson Osteopathic Family Practice Residency, Johnson City Family Care Center, 40 Arch St, Johnson in the community should not exceed 5% showing atypia with reparative changes City, NY 13790. of the Pap smear findings.6 In a screened have a high spontaneous regression rate Terry • Brief report JAOA • Vol 96 • No 8 • August 1996 • 465 and may be managed conservatively. Conversely, Pap smears that meet the ASCUS criteria indicate the need for more aggressive treatment. The distinction between the ASCUS smear and a smear showing reactive change and low-grade SIL is a problem. In fact, one study com­ paring interpretations by two sets of pathologists showed significant intraob­ server variability between the diagnosis of ASCUS versus HSIL and LSIL. It is appropriate that whenever an ASCUS smear is obtained there be some qualifi­ cations of the diagnosis.3.6 Management of the patient with an ASCUS smear is a dilemma for the clin­ ician. Proper triage is essential, as 20% or more ASCUS smears may represent SILJ.9. It is imperative that in patients in whom ASCUS represents a more advanced disease (that is, HSIL or inva­ sive cancer), the disease be identified and treated promptly.10 Colposcopy For further evaluation of advanced squa­ mous intraepitheliallesions, colposcopy is recommended. Yet, optimal manage­ ment of the patient with the ASCUS smear has yet to be defined. Some clini­ cians advocate colposcopy for all women with the ASCUS smear, whereas others recommend a "wait-and-see" approach and follow-up with repeated Pap tests. Several treatment options are available for Figure 2. Papanicolaou's test showing dysplasia. management of patients with the ASCUS smear. Careful review of all the clinical data pertinent to each case, taking into an unqualified diagnosis of ASCUS smear high fa lse-negative rate at the time of consideration previous Pap smear find­ or, if the cytopathologist favors a reactive colposcopy.8.10.12 A 1995 study of ings and any qualifications that the process, the Pap test may be repeated in patients with LSIL who were followed up pathologist may have provided regarding 4 to 6 months. If the smear shows nor­ conservatively with repeated Pap smears the diagnosis of the ASCUS smear, and mal cell s, the Pap test should be repeat­ demonstrated an unacceptably low sen­ evaluation of the patient's risk factors ed every 4 to 6 months until three con­ sitivity of the Pap smear. 13 Whether this for cervical neoplasia must be completed secutive negative smears appear.6 The information can be applied to conserva­ before triage. patient then can be followed up annual­ tive management of the patient with the One approach would be simply to ly. A second ASCUS smear mandates a ASCUS smear has yet to be determined. repeat the Pap test. At least half of colposcopic evaluation. This strategy can The Pap smear is of va lue as a screening ASCUS smears will regress over time. be safely applied to patients at low risk test, but it should not be considered a Montz and colleaguesll have reported a for cervical cancer. Patients with a history reliable diagnostic tool once an abnor­ 54% regression rate of ASCUS smears. In of Pap tests showing abnormality or mality has been identified. their study, 46% of patients continued to patients who have other risk factors may A patient with an ASCUS smear asso­ show ASCUS abnormalities but none require colposcopy after the first ASCUS ciated with inflammation should be progressed after 9 months of follow-up. smear. reevaluated in 2 to 3 months. If a specific Average regression time was 3.5 months. Critics of this conservative approach infection is identified, the patient should This approach is indicated in the case of point out that repeated Pap tests have a be treated and have another Pap test in 466 • ]AOA • Vol 96 • No 8 • August 1996 Terry · Brief report and 93 % in predicting HSIL. HPV-DNA Papanicolaou smear su btyping favorably compared with fol­ shows atypical squamous cells of undetermined low-up Pap smears, which showed sen­ significance (ASCUS) sitivities of only 60% and 73%, respec­ tively.l5 Cox and coworkers conclude I that high viral levels of HPV types asso­ ciated with cervical cancer are predictive I I I of high-grade lesions and that patients with ASCUS smears can be triaged based Smear with Epithelial Patient is ASCUS unqualified changes are post- represents on HPV testing results. Omer data are reparative secondary to menopausal premalignant less conclusive about me role of HPV­ cellular inflammation changes/ DNA subtyping.16,1? !t is estimated that neoplasia changes 11 % to 18 % of normal cervices contain HPV DNA.I? This presence of HPV DNA may represent dormant HPV infec­ J + tion that will eventually manifest as SIL, • Treat infec- • Institute trial • Repeat • • Do colpos- but this possibility has not been proved. Pap tion if noted of estrogen copy smear in • Repeat therapy In addition, it has been demonstrated in 4 to 6 Pap smear • Repeat other studies that the hybrid-capture months in 3 months Pap smear in DNA test was insufficiently sensitive in 4 to 6 months identifying high-grade lesions and overt cervical carcinoma.16 Figure 3.
Load more

Recommended publications
  • Comparative Accuracy of Anal and Cervical Cytology in Screening for Moderate to Severe Dysplasia by Magnification Guided Punch Biopsy: a Meta-Analysis
    Comparative Accuracy of Anal and Cervical Cytology in Screening for Moderate to Severe Dysplasia by Magnification Guided Punch Biopsy: A Meta-Analysis Wm. Christopher Mathews*, Wollelaw Agmas, Edward Cachay Department of Medicine, University of California San Diego, San Diego, California, United States of America Abstract Background: The accuracy of screening for anal cancer precursors relative to screening for cervical cancer precursors has not been systematically examined. The aim of the current meta-analysis was to compare the relative accuracy of anal cytology to cervical cytology in discriminating between histopathologic high grade and lesser grades of dysplasia when the reference standard biopsy is obtained using colposcope magnification. Methods and Findings: The outcome metric of discrimination was the receiver operating characteristic (ROC) curve area. Random effects meta-analysis of eligible studies was performed with examination of sources of heterogeneity that included QUADAS criteria and selected covariates, in meta-regression models. Thirty three cervical and eleven anal screening studies were found to be eligible. The primary meta-analytic comparison suggested that anal cytologic screening is somewhat less discriminating than cervical cytologic screening (ROC area [95% confidence interval (C.I.)]: 0.834 [0.809–0.859] vs. 0.700 [0.664–0.735] for cervical and anal screening, respectively). This finding was robust when examined in meta-regression models of covariates differentially distributed by screening setting (anal, cervical). Conclusions: Anal cytologic screening is somewhat less discriminating than cervical cytologic screening. Heterogeneity of estimates within each screening setting suggests that other factors influence estimates of screening accuracy. Among these are sampling and interpretation errors involving both cytology and biopsy as well as operator skill and experience.
    [Show full text]
  • Subclinical Human Papillomavirus Infection of the Cervix
    Subclinical human papillomavirus infection of the cervix Makram M. Al-Waiz, PhD, MBChB, Rabab N. Al-Saadi, FICMS, MBChB, Zahida A. Al-Saadi, MRCOG,MBChB, Faiza A. Al-Rawi, FICPath, MBChB. ABSTRACT Objectives: A prospective study to investigate a group 3 (15%) showed moderate dysplastic changes, whilst 2 of Iraqi woman with proved genital vulval warts, to seek (10%) showed no dysplastic changes. Speculoscopy and evidence of human papillomavirus infection in apparently acetowhitening was positive in 11 (55%) and collated normal looking cervixes and to investigate the natural histological results showed evidence of human history of infection. papillomavirus infection in 9 patients (45%). As for the control group one case (5%) had evidence of human Methods: From December 1997 to August 1998, 20 papillomavirus infection. women with vulval warts were enrolled along with 20 aged-matched control cases without warts. Their ages Conclusions: Subclinical human papillomavirus ranged between 19-48 years with a mean of 30.4 years, (+/ infection is more common than was previously thought - standard deviation = 2.3) for patients and 18-48 years among Iraqi women. It may appear alone or in association with a mean of 29.7 (+/- standard deviation = 2.7) for the with vulval or exophytic cervical warts, or both, and may control group. General and gynecological examinations be more common than the clinically obvious disease. were carried out. Cervical swabs for associated genital Speculoscopy as an adjunctive method to colposcopy was infection, papilloma smears, speculoscopy and directed found to be a simple and an easy to perform technique. Its punch biopsies were carried out to detect subclinical combination with cytology gave relatively good results human papillomavirus infections of the cervix and when it was used as a triage instrument, and may have a associated intraepithelial neoplasm.
    [Show full text]
  • 1 the Progress Report Research Project Entitled
    The progress report Research project entitled: Research for Development of an Optimal Policy Strategy for Prevention and Control of Cervical Cancer in Thailand Written by The research team from International Health Policy Program (IHPP) Health Intervention and Technology Assessment Program (HITAP) Submitted to Population and Reproductive Health Capacity Building Program The World Bank August 2007 1 I. Introduction Cervical cancer is the second most common cancer which accounts for 12% of all cancers in women worldwide [1]. The disease caused approximately 470,600 new cases and 233,400 deaths per year with 83% of these cases found in developing counties [1]. Unfortunately, there has been no effective treatment for curing advanced stage of cervical carcinoma. Thus, the early detection of the abnormal cell growth by performing regular cytological screening either papanicolaou (Pap) smear or direct visual inspection has been recommended in usual clinical practice [2]. Recently, there have been substantial evidence supporting that persistent infection of the cervix with high-risk types of human papillomavirus (HPV) leads to the development of cervical cancer [3]. Therefore, HPV DNA method has been introduced as a specific test for the viral infection causing cervical cancer. However, the sensitivity, specificity, cost, advantages and disadvantages of these methods are varied [4-6]. In addition, a vaccine that prevents infections known to cause cervical cancer is now available though there are still many critical issues related to the introduction of new and expensive vaccine that need to be considered; namely whether the introduction of the HPV vaccine would place increase burden on public health system and financing system, whether the vaccine presents ‘a good value for money’ for public support, how to ensure its reliable long-term financing, and what needed to be done for integration of other preventive approaches such as secondary screening.
    [Show full text]
  • Validity of Colposcopy in the Diagnosis of Early Cervical Neoplasia – a Review
    http://www.bioline.org.br/request?rh02036 Bioline International HOME JOURNALS REPORTS NEWSLETTERS BOOKS SAMPLE PAPERS RESOURCES FAQ African Journal of Reproductive Health, ISSN: 1118-4841 Women's Health and Action Research Centre African Journal of Reproductive Health, Vol. 6, No. 3, December, 2002 pp. 59-69 Validity of Colposcopy in the Diagnosis of Early Cervical Neoplasia – A Review Olayinka Babafemi Olaniyan Correspondence: Dr O. B. Olaniyan, Department of Obstetrics & Gynaecology, National Hospital, PMB 425, Abuja, Nigeria. E-mail: [email protected] Code Number: rh02036 ABSTRACT This study was conducted to quantify by meta-analysis the validity of colposcopy in the diagnosis of early cervical neoplasia in order to assess the justification of its integral role in this regard. Eight longitudinal studies were selected, which compared correlation of colposcopic impression with colposcopically directed biopsy results. The prevalence of disease in the studies ranged from 40 to 89%. Colposcopic accuracy was 89%, which agreed exactly with histology in 61% of cases. The sensitivity and specificity of colposcopy for the threshold normal versus all cervical abnormalities were 87–99% and 26–87% respectively. For the threshold normal and low grade SIL versus high grade SIL, the values were 30–90% and 67–97%. Likelihood ratios increased with disease severity. Colposcopy performed better in differentiation of high grade from low grade disease than in differentiation of low grade disease from normal cervix. Colposcopy is a valid tool for the diagnosis of early cervical neoplasia. Its integral role in the management of early cervical disease is justified. (Afr J Reprod Health 2002; 6[3]: 59–69) http://www.bioline.org.br/request?rh02036 (1 of 14)10/20/2004 11:37:49 AM http://www.bioline.org.br/request?rh02036 RÉSUMÉ La validité de la colposcopie dans le diagnostic de la néoplasie cervicale précoce: compte rendu.
    [Show full text]
  • Cervical Cancer Screening Visualization Technologies
    Cigna Medical Coverage Policy Effective Date ............................ 9/15/2014 Subject Cervical Cancer Screening Next Review Date ...................... 9/15/2015 Coverage Policy Number ................. 0127 Visualization Technologies Table of Contents Hyperlink to Related Coverage Policies Coverage Policy .................................................. 1 Human Papillomavirus Vaccine ® ® General Background ........................................... 1 (Cervarix ,Gardasil ) Coding/Billing Information ................................... 8 References .......................................................... 8 INSTRUCTIONS FOR USE The following Coverage Policy applies to health benefit plans administered by Cigna companies. Coverage Policies are intended to provide guidance in interpreting certain standard Cigna benefit plans. Please note, the terms of a customer’s particular benefit plan document [Group Service Agreement, Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document] may differ significantly from the standard benefit plans upon which these Coverage Policies are based. For example, a customer’s benefit plan document may contain a specific exclusion related to a topic addressed in a Coverage Policy. In the event of a conflict, a customer’s benefit plan document always supersedes the information in the Coverage Policies. In the absence of a controlling federal or state coverage mandate, benefits are ultimately determined by the terms of the applicable benefit plan document. Coverage determinations in each specific instance require consideration of 1) the terms of the applicable benefit plan document in effect on the date of service; 2) any applicable laws/regulations; 3) any relevant collateral source materials including Coverage Policies and; 4) the specific facts of the particular situation. Coverage Policies relate exclusively to the administration of health benefit plans. Coverage Policies are not recommendations for treatment and should never be used as treatment guidelines.
    [Show full text]
  • Colposcopy of the Uterine Cervix
    THE CERVIX: Colposcopy of the Uterine Cervix • I. Introduction • V. Invasive Cancer of the Cervix • II. Anatomy of the Uterine Cervix • VI. Colposcopy • III. Histology of the Normal Cervix • VII: Cervical Cancer Screening and Colposcopy During Pregnancy • IV. Premalignant Lesions of the Cervix The material that follows was developed by the 2002-04 ASCCP Section on the Cervix for use by physicians and healthcare providers. Special thanks to Section members: Edward J. Mayeaux, Jr, MD, Co-Chair Claudia Werner, MD, Co-Chair Raheela Ashfaq, MD Deborah Bartholomew, MD Lisa Flowers, MD Francisco Garcia, MD, MPH Luis Padilla, MD Diane Solomon, MD Dennis O'Connor, MD Please use this material freely. This material is an educational resource and as such does not define a standard of care, nor is intended to dictate an exclusive course of treatment or procedure to be followed. It presents methods and techniques of clinical practice that are acceptable and used by recognized authorities, for consideration by licensed physicians and healthcare providers to incorporate into their practice. Variations of practice, taking into account the needs of the individual patient, resources, and limitation unique to the institution or type of practice, may be appropriate. I. AN INTRODUCTION TO THE NORMAL CERVIX, NEOPLASIA, AND COLPOSCOPY The uterine cervix presents a unique opportunity to clinicians in that it is physically and visually accessible for evaluation. It demonstrates a well-described spectrum of histological and colposcopic findings from health to premalignancy to invasive cancer. Since nearly all cervical neoplasia occurs in the presence of human papillomavirus infection, the cervix provides the best-defined model of virus-mediated carcinogenesis in humans to date.
    [Show full text]
  • Planning Appropriate Cervical Cancer Prevention Programs
    Planning Appropriate Cervical Cancer Prevention Programs 2nd Edition 2000 Program for Appropriate Technology in Health Support for development of this document was provided by the Bill & Melinda Gates Foundation through the Alliance for Cervical Cancer Prevention. ©PATH, 2000. All rights reserved Using This Document Any part of Planning Appropriate Cervical Cancer Prevention Pro- grams, 2nd Edition may be reproduced or adapted to meet local needs without prior permission from PATH, provided that PATH is acknowl- edged and the material is made available free of charge or at cost. Please send a copy of all adaptations to: Cervical Cancer Prevention Team PATH (Program for Appropriate Technology in Health) 4 Nickerson Street Seattle, WA 98109 USA Tel: (206) 285-3500 Fax: (206) 285-6619 Email: [email protected] Readers are encouraged to use document sections to educate others about the impact of cervical cancer and potential prevention strategies. iii Acknowledgements The lead authors of Planning Appropriate Cervical Cancer Prevention Programs, 2nd Edition, are Cristina Herdman and Jacqueline Sherris, with key contributions from Amie Bishop, Michele Burns, Patricia Cof- fey, Joyce Erickson, John Sellors, and Vivien Tsu. Support for develop- ment of this document was provided by the Bill & Melinda Gates Foundation through the Alliance for Cervical Cancer Prevention. Planning Appropriate Cervical Cancer Prevention Programs, 2nd Edi- tion, is the revised and updated version of Planning Appropriate Cervical Cancer Control Programs, published by PATH in 1997. The original publication was prepared by a team of PATH staff who work on a range of issues related to cervical cancer prevention. The lead author of the original publication was Jacqueline Sherris; key contributions were made by Amie Bishop, Elisa Wells, Vivien Tsu, and Maggie Kilbourne-Brooke.
    [Show full text]
  • Relative Accuracy of Cervical and Anal Cytology for Detection of High Grade Lesions by Colposcope Guided Biopsy: a Cut-Point Meta-Analytic Comparison
    Relative Accuracy of Cervical and Anal Cytology for Detection of High Grade Lesions by Colposcope Guided Biopsy: A Cut-Point Meta-Analytic Comparison Edward R. Cachay*, Wollelaw Agmas, William C. Mathews Department of Medicine, University of California at San Diego, San Diego, California, United States of America Abstract Background: We recently reported, using a receiver operating characteristic area metric, the first meta-analytic comparison of the relative accuracy of cervical and anal cytology in detecting moderate or severe histopathologic lesions by magnification directed punch biopsy. The aim of the present research was to meta-analytically examine cut-point specific operating characteristics (sensitivity, specificity) of cervical and anal cytology in detecting high grade squamous intraepithelial lesion (HSIL) histopathology by colposcope directed punch biopsy. Methodology/Principal Findings: The primary eligibility requirement was availability of tabulated cytology (normal, atypical cells of unclear significance [ASCUS], low grade squamous intraepithelial lesion, HSIL or atypical squamous cells cannot rule out high grade [ASC-H]) and biopsy (,HSIL, $ HSIL) counts. Meta-analysis and meta-regression of diagnostic accuracy was performed with examination of study quality criteria and heterogeneity. Thirty-three cervical and 11 anal publications were eligible between 1990 and 2010. Meta-analytically cut-point analysis showed that using a cut-point of ASCUS the sensitivity in both settings is similar while anal cytology is less specific than cervical cytology (specificity [95% confidence interval] 0.33 [0.20–0.49] vs. 0.53[0.40–0.66], p = 0.04) for the detection of HSIL histopathology by colposcope directed punch biopsy. Conclusions/Significance: Using a cytology cut-point of HSIL or ASC-H, anal cytology is less sensitive but comparably specific to cervical cytology.
    [Show full text]
  • CERVICAL CANCER SCREENING – Dr
    CERVICAL CANCER SCREENING – Dr. Zubair Syed, UTSW Family Medicine, 2/2015 HISTORY Age Parity, last pregnancy Menstrual History (Menarche/LMP), Sexual history Last PAP, Any history of abnormal PAP Surgical History (TAH, LEEP etc.) – reasons for getting the procedure. Risk factors (H/O STDs, multiple partners) HPV vaccination status Current symptoms (Any vaginal itching, discharge, rash, lesions etc.) PHYSICAL EXAM VULVA: tenderness, excoriation, lesion, nodule, mass. VAGINA: Lesions, edema, mass, discharge. CERVIX: Friable, erythematous, ectropion, lesion, cervical discharge, cervical motion tenderness, surgically absent, Nabothian cyst at *** o'clock, endocervical polyp size *** cm. UTERUS: surgically absent, vaginal cuff well healed, tenderness, mass, anteverted, retroverted, enlarged to *** week's size, irregular, mobile, fixed, ADNEXA: tenderness, masses. ABDOMINAL: Bimanual exam – comment on any masses felt between your digits and hand. Don’t Forget To Document who was your Chaperone During The Exam!!! SCREENING RECOMMENDATIONS In 2012, the ACS, ASCCP, USPSTF, ACOG and ASCP issued new screening guidelines. Screening recommendations for specific patient age groups are as follows: < 21 years – No screening recommended 21-29 years – Cytology (Pap smear) alone every 3 years 30-65 years – Human papillomavirus (HPV) and cytology co-testing every 5 years (preferred) or cytology alone every 3 years (acceptable) > 65 years – No screening recommended if adequate prior screening has been negative and high risk factors are not present. The USPSTF cautions that positive screening results are more likely with HPV-based strategies than with cytology alone and that some women may have persistently positive HPV results and require prolonged surveillance with additional frequent testing. Similarly, women who would otherwise be advised to end screening at age 65 years on the basis of previously normal cytology results may undergo continued testing because of positive HPV test results.
    [Show full text]
  • Should All Women with Cervical Atypia Be Referred for Colposcopy: a HARNET* Study David C
    Should All Women with Cervical Atypia Be Referred for Colposcopy: A HARNET* Study David C. Slawson, MD; Joshua H. Bennett, MD; Laura J. Simon, MA; and James M. Herman, MD, MSPH Harrisburg and H m hey, Pennsylvania Background. Clinicians who manage women with Pa­ Pap smear alone for detecting these cases of condyloma panicolaou (Pap) smears showing atypical squamous and CIN was significantly decreased (false-negative cells of undetermined significance (ASCUS) may miss rate, 27%) with the use of the cervical acetic acid wash clinically significant cervical disease by repeating the cy­ as an adjunctive test. There was no additional reduc­ tology alone. We evaluated the ability of the human tion in the false-negative rate with the use of the HPV papillomavirus (HPV) screen and the naked-eye exami­ screen. Of the 15 subjects with high-grade cervical le­ nation after a cervical acetic acid wash to enhance the sions (CIN II to III), 14 had cither an abnormal lol- follow-up Pap smear in predicting an abnormal colpo- low-up Pap smear or an abnormal cervical acetic acid scopic biopsy. wash examination. Methods. Pap smears were performed on all women (N Conclusions. Among women with cervical atypia, a sin­ = 7458) attending six family practice offices for a gle follow-up Pap smear alone failed to detect one health maintenance examination from August 1989 through February 1991. Consenting subjects with third of the cases of high-grade disease. Ninety-three ASCUS underwent repeat cytological testing, an HPV percent of these cases were detected, however, with a screen, and a cervical acetic acid wash examination im­ follow-up Pap smear and an acetic acid wash.
    [Show full text]
  • For Peer Review Only Journal: BMJ Open
    BMJ Open BMJ Open: first published as 10.1136/bmjopen-2016-015653 on 17 July 2017. Downloaded from Human papillomavirus prevalence, genotype distribution and HPV16 variants among young women and men in Maputo city, Mozambique For peer review only Journal: BMJ Open Manuscript ID bmjopen-2016-015653 Article Type: Research Date Submitted by the Author: 21-Dec-2016 Complete List of Authors: Viegas, Edna; Instituto Nacional de Saúde; Karolinska Institutet, Department of Laboratory Medicine Ismael, Nália; Instituto Nacional de Saúde Kaliff, Mallin; Orebro Universitet, Department of Laboratory Medicine, Faculty of Medicine and Health Lillsunde-larsson, Gabriella; Orebro Universitet, Department of Laboratory Medicine, Faculty of Medicine and Health Ramqvist, Torbjorn; Karolinska Institutet, Department of Oncology- Pathology Augusto, Orvalho; Universidade Eduardo Mondlane Nilsson, Charlotta; Karolinska Institutet, Department of Laboratory Medicine; Folkhalsomyndigheten Falk, Kerstin; Karolinska Institutet, Department of Microbiology, Tumor and http://bmjopen.bmj.com/ Cell Biology; Folkhalsomyndigheten Osman, Nafissa; Hospital Central de Maputo Jani, Ilesh; Instituto Nacional de Saúde Andersson, Sören; Orebro Universitet, Department of Laboratory Medicine, Faculty of Medicine and Health <b>Primary Subject Infectious diseases Heading</b>: on September 26, 2021 by guest. Protected copyright. Secondary Subject Heading: Epidemiology INFECTIOUS DISEASES, Epidemiology < INFECTIOUS DISEASES, Molecular Keywords: diagnostics < INFECTIOUS DISEASES, Public health < INFECTIOUS DISEASES For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 22 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2016-015653 on 17 July 2017. Downloaded from 1 2 Human papillomavirus prevalence, genotype distribution and HPV16 variants among 3 young women and men in Maputo city, Mozambique 4 5 Viegas, EO1,2,3*, Ismael N1, Kaliff M4, Lillsunde-Larsson G4, Ramqvist T5, Augusto O3, 6 Nilsson C2,6,7, Falk K.I.6,7, Osman N3,8, Jani IV1, Andersson S4 7 8 9 10 11 1.
    [Show full text]
  • What Is Controversial in Cervical Cancer Screening?
    Evidencia científica sobre nuevas tecnologías para el cribado del cáncer cervicouterino Eduardo L. Franco Professor, Departments of Epidemiology and Oncology Director, Division of Cancer Epidemiology McGill University, Montreal, Canada Topics to cover ¾ Cytology screening as the paradigm of cervical cancer control: Glory for some, failure for many. ¾ Cervical cancer screening technologies. ¾ Rationale and burden of proof for HPV DNA testing in primary screening for cervical cancer. ¾ Post-HPV vaccination era: need for a paradigm change that combines primary and secondary prevention. Age standardized incidence of invasive cervical cancer and coverage of screening, England, 1971-95 (Quinn et al., BMJ 1999; 318: 904-8) PapPap CytologyCytology ScreeningScreening CoverageCoverage andand CervicalCervical CancerCancer MortalityMortality inin LatinLatin AmericaAmerica 25 20 15 10 Mortality (per 100,000 women per year) 20 30 40 50 60 70 80 Screening coverage previous 12 months (%) Courtesy of Dr. Raul Murillo, Nat’l Cancer Inst, Colombia ScreeningScreening hashas multiplemultiple interconnectedinterconnected components,components, allall ofof whichwhich mustmust functionfunction WithoutWithout anan organizedorganized programme,programme, PapPap cytologycytology coveragecoverage isis misleadingmisleading asas indicatorindicator ofof successsuccess becausebecause itit reflectsreflects accessaccess toto carecare forfor womenwomen atat lowestlowest risk.risk. FailureFailure ofof otherother componentscomponents ofof aa screeningscreening programme:programme:
    [Show full text]