Cervical Cancer and Its Precursors: A Preventative Approach to Screening, Diagnosis, and Management

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Key points

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    Screening for cervical cancer—through cytology testing, human papilloma virus testing, or a combination of the two—looks to detect preinvasive disease, thereby allowing for medical intervention before invasive disease has developed.

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    Although human papilloma virus DNA is present in the majority of cervical cancers, there are a myriad other risk factors that impact a woman’s likelihood of developing the disease.

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    Cervical cancer screening has resulted in declines in disease incidence and mortality,

Clinical description of disease

Cervical cancer affects the cells lining the cervix, most commonly occurring in the cells of the transformation zone, which is the part of the cervix where the glandular cells of the endocervix meet the squamous cells of the exocervix. Approximately 70% of cervical cancers are of the squamous cell type and nearly 25% are of the adenocarcinoma type that develop from glandular cells. Other types of cervical cancer may also occur, but are extremely rare.1 Cervical cancer generally develops over

Screening Rates

Cervical cancer screening has resulted in well-documented declines in incidence and mortality in the United States.28 Most new cervical cancer cases occur in women who have never or rarely been screened.29 For example, the Southern United States experiences a higher cervical cancer disease burden while also reporting lower HPV vaccine uptake and Pap smear screening rates.30

As such, Healthy People 2020 includes goals to increase screening rates for breast, cervical, and colorectal cancers. For

Screening recommendations

Guidelines surrounding the type of screening, optimal interval, and risk–benefit considerations continue to evolve as new data emerges. There are currently 3 main options for screening: cytology, HPV testing, and visual inspection (Fig. 1). Selection depends on the age of the patient and type of resources available in the population being screened. In the United States, the wide use of both cytology and HPV testing is standard of care. However, in developing countries and very low resource

Prevention recommendations

Although cervical cancer prevention strategies can include behavioral interventions directed toward limiting number of sexual partners, condom use, and reduction in cigarette smoking, vaccination against high-risk HPV represents the most direct targeted strategy.44

There are 3 HPV vaccines approved by the US Food and Drug Administration for use in the United States, although only the 9-valent GARDASIL vaccine is currently in use.45 All 3 are L1 protein vaccines that induce the formation of

Outcomes and complications of cervical cancer screening

Potential outcomes of cervical cancer screening include normal and abnormal screening results. Normal results may include negative cytology and/or the absence of HPV depending on the testing strategy used and, in these instances, the resumption of screening at the recommended, routine intervals is indicated (generally either every 3 or every 5 years). Abnormal results may include various pathologic cytology findings or the presence of certain HPV genotypes. Table 5 lists potential outcomes of

Summary

Cervical cancer affects the cells lining the cervix, most commonly occurring in the cells of the transformation zone. Persistent infection with the HPV is implicated in the vast majority of cervical cancer cases; other risk factors include smoking, immunocompromise, increasing number of sexual partners, increasing number of pregnancies, and lower socioeconomic status.

Screening for cervical cancer—either through the cytology testing with the Pap smear, HPV testing, or a combination—looks to

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    Disclosure: The authors have nothing to disclose.

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