CERVICAL CANCER
Cervical
intraepithelial neoplasia (CIN) is the precur-sor lesion to
cervical cancer. CIN may regress sponta-neously, but, in some cases, CIN 2 and
CIN 3 progresses to cancer over time. Exfoliative cytology,specifically thePap test (either slide or liquid-based) with or without
type-specific HPV identification, allow early diagnosis in most cases. The
reduction in mortality from cervical cancer since the Pap test was introduced
in the 1940s is testimony to the success of this screening program.
The following are recommendations for cervical
can-cer screening for women:
·
Annual cervical cytology
screening should begin ap-proximately 3 years after initiation of sexual
inter-course, but no later than age 21 years. Women younger than 30 years
should undergo annual cervical cytology screening.
·
Women who have had 3 consecutive
negative annual Pap test results may be screened every 2 to 3 years if they are
age 30 or older with no history of CIN 2 or 3, immunosuppression, HIV
infection, or diethylstilbes-trol (DES) exposure in utero. Annual cervical
cytology is another option for women 30 years and older. The use of combination
cervical cytology and human papil-lomavirus (HPV) DNA screening is appropriate
for women 30 years and older. Women who receive nega-tive results on both tests
should be rescreened no more frequently than every 3 years.
·
Women who have had a total
hysterectomy (removal of the uterus and cervix) for reasons other than cervical
cancer no longer need to be screened for cervical cancer. Women who have had a
supracervical hysterectomy should continue to be screened. Women who have
undergone hysterectomy with removal of the cervix and have a history of CIN 2
or CIN 3 should continue to be screened annually until three consecutive
negative vagi-nal cytology test results are achieved.
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