CERVICAL NEOPLASIA

Bethesda Classification for Pap Smears (1991)

HPV Testing in Cervical Cancer Screening

HPV Vaccination

Management of Abnormal Paps

Staging of Cervical Cancer

Treatment of Cervical Cancer

n.b. Paps not considered necessary after hysterectomy for benign disease (would be a screen for vaginal cancer, which is the least common of pelvic cancers)

Intervals for pap screening--See also Preventive Screening--Collated Recommendations from Various Organizations:

• Case-control study of 92 women w/invasive cervical Ca and 178 healthy female controls, looking at mean interval between pap smears for the 10y preceding dx of Ca (or contact, for controls), found RR 3.9 (95% CI 1.2-12.3) for invasive Ca for women w/ 3y pap intervals c/w those w/ 1y intervals; No sig. diff in risk for 2y intervals c/w 1y intervals (RR 1.01, 95% CI 0.43-2.37). No change in results w/adjustment for cervical Ca risk factors (Obs. Gyn 74:838, 1989-done at UW)
• Using data from a cohort of 938,576 women < 65yo and a "Markov model," one group of researchers estimated that the 3y excess risk of invasive cervical cancer associated with paps Q3y rather than Q1y is about 3/100,000 (NEJM 349:1501, 2003--abst)

Risk factors for cervical cancer:

• Multiple sexual partners
• Uncircumcised male sexual partners (in a study pooling data from 5 case-control studies; NEJM 346:1105, 2002--JW)
• Smoking
• HIV infection
• HPV infection
• Chlamydial infection--In a case-control study of 128 women with invasive squamous cell carcinoma of the cervix and 384 controls, 3 serotypes of Chlamydia trachomatis (G, I, and D) were sig. ass'd with SCC (OR 6.6, 3.8, and 2.7, respectively), after adjustment for incidence of Ab to high-risk HPV strains and serum cotinine (marker for smoking) (JAMA 285:47, 2001--JW