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Cervical Cancer Screening And Management In Pregnancy
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Vaidehi Mujumdar, Scott D. Richard
The Pap smear is used to screen for cellular abnormalities that are associated with an increased risk for the development of cervical cancer. It selects those women who should have further evaluation, such as HPV DNA testing, colposcopy, and/or biopsy, which then is used for treatment decisions. The National Comprehensive Cancer Network (NCCN) panel has adopted recommendations set forth by the American Cancer Society on initiation and frequency of Pap smear [17]. Of note, ACS has new 2020 recommendations that include that people with a cervix ages 25–65 get a primary HPV test every 5 years as the preferred screening method. They do not recommend cervical cancer screening in patients less than 25 years of age [3]. The primary HPV test, the cobas test, is manufactured by Roche and can be used alone for screening. This test detects 14 “high-risk” HPV types, while also specifically identifying HPV 16 and 18. The rationale remains that invasive cancer is rare in women under 21. Annual surveillance is recommended for patients with known immunosuppression from HIV or organ transplantation; individuals exposed to diethylstilbestrol in utero; or those who have been previously treated for CIN 2, CIN 3, or cervical cancer [3]. Pap smears are often obtained at the first prenatal visit by many providers, but the guidelines for nonpregnant patients (HPV test every 5 years for patients ≥25 years old) can be followed in pregnant patients [10].
Screening and Diagnostic Tests
Published in Marcello Pagano, Kimberlee Gauvreau, Heather Mattie, Principles of Biostatistics, 2022
Marcello Pagano, Kimberlee Gauvreau, Heather Mattie
Cervical cancer is a disease for which the chance of containment is high given that it is discovered early. The Pap smear is a widely accepted screening test used to detect the abnormal growth of cells on the surface of the cervix in females who are as yet asymptomatic. It has been credited with being primarily responsible for the decreasing death rate due to cervical cancer. A large study conducted in Canada evaluated the performance of the Pap smear for detecting cervical intraepithelial neoplasia [143]. The test was performed in groups of females with and without cervical cancer, as determined by colposcopy and biopsy.
MODELS TO AID IN PLANNING CANCER SCREENING PROGRAMS
Published in Richard G. Cornell, Statistical Methods for Cancer Studies, 2020
Michael Shwartz, Alonzo L. Plough
b. Cervical cancer. The use of the Pap smear as a screening technique to detect cervical cancer is widespread. However, no randomized controlled trials have been performed to evaluate the Pap smear. Hence, though there is circumstantial evidence indicating the Pap smear has reduced mortality from cervical cancer, the efficacy of this technique is still somewhat controversial. The controversy centers around two points: one, the extent to which and rate at which carcinoma in situ (c.i.s.), the disease
Advancing cervical cancer diagnosis and screening with spectroscopy and machine learning
Published in Expert Review of Molecular Diagnostics, 2023
Carlos A. Meza Ramirez, Michael Greenop, Yasser A. Almoshawah, Pierre L. Martin Hirsch, Ihtesham U. Rehman
Persistent human papillomavirus (HPV), especially the high-risk HPV-16 and HPV-18, is known to be essential for cervical cancer to occur [10]. Risk factors for HPV include smoking, HIV, low socioeconomic level, multiple sexual partners, and because HPV is a sexually transmitted infection, sexual intercourse before the age of 16 [10]. The current approach to cervical cancer screening is a Pap smear test, an invasive procedure causing lowered participation [8]. Further diagnosis can be carried out by white light colposcopy with a sensitivity of ~ 96% but a specificity of ~ 48% [11]. A biopsy is the gold standard for diagnosis but is further invasive and can be impractical for patients with several suspicious lesions [11]. Developing new approaches could provide improvements in the overall accuracy of cervical cancer diagnosis, as well as a more accessible sample collection.
Comparison of conventional and liquid-based Pap smear methods in the diagnosis of precancerous cervical lesions
Published in Journal of Obstetrics and Gynaecology, 2022
Zahra Honarvar, Zahra Zarisfi, Saideh Salari Sedigh, Maryam Masoumi Shahrbabak
Of 31,513 women examined by CN and LBC, CN was performed for more than half of subjects (n = 17,074, 54.2%) and others were examined by LBC. According to Pap smear findings, 2330 people with abnormal Pap smear again checked with colposcopy. For 17 persons with the normal Pap smear result, the colposcopy also performed due to the observation of gross tissue during Pap smear procedures. The mean (±SD) age of subjects with abnormal Pap smear was 40.60 (10.38) years (age range: 21–82). The liquid-based Pap smear was positive for more than half of the subjects (n = 1470, 62.6%) and other positive results were reported by the conventional method (n = 878, 37.4%). Unsatisfactory smear was seen in little of subjects (n = 15, 0.6%) and the ASCUS+ was more prevalent among them (n = 968, 41.2%). The results showed that conventional methods in comparison to liquid-based cytology had more unsatisfactory smears (1.4% vs. 0.2%, p ≥ .001) and reported frequent ASCUS+ (45.1% vs. 35.4%, p ≥ .001). In contrast, LSIL+ was more reported by LBC versus conventional method (38.9% vs. 33.1%, p = .005). There was no significant difference based on Pap smear findings between the two methods (Table 1).
Don’t jump down my throat: gender gap in HPV vaccinations risk long term cancer threats
Published in Expert Review of Vaccines, 2022
Armaan Mehta, Bethany Markman, William Rodriguez-Cintron
HPV vaccine completion rates are substantially lower in men than in women. This paper covered many factors that contribute to this, including poor pediatric visitation rates after age 6, differing visitation expectations between girls and boys, a general disregard for healthcare in adolescents, and most importantly, genderization and sexism. The only major healthcare visitation expected during the indicated vaccination time is for girls to start seeing an OBGYN. But many, if not most, women typically wait until their first pap smear at 21 or sometimes later to see one. Men have no comparable resource to this. The HPV vaccine sits in an unfortunate sinkhole of care where adolescents are expected to see pediatricians or specialists, but do not actually do so. Pragmatically, this paper proposes two feasible options: improve healthcare visitation/vaccination among the indicated adolescent population or change the indications/indicated age range for the HPV vaccination.