Colorectal Carcinoma

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.

COLORECTAL CARCINOMA

With over 75,000 new cases of colorectal cancer annu-ally in women and over 25,000 deaths, colorectal cancer is the third leading cause of cancer death in women, after lung cancer and breast cancer. Because early detection (preinvasive or early invasive stage) allows effective man-agement for most patients, screening is appropriate and recommended.

Screening for colorectal cancer is recommended for all women at average risk, starting at the age of 50. The preferredmethod is colonoscopy, performed every 10 years.

Other acceptable screening tests include:

·  Annual fecal occult blood testing (FOBT) or fecalimmunochemical testing (FIT)

·  Flexible sigmoidoscopy every 5 years. This test will miss right-sided lesions, which may account for up to 65% of advanced colorectal cancers in women.

·  Combination of annual fecal occult blood testing and flexible sigmoidoscopy

·  Double contrast barium enema every 5 years

Both FOBT and FIT require two or three samples of stool collected by the patient at home and returned for analysis. Screening by FOBT of a single stool sample from a rectal examination by the physician is not adequate for the de-tection of colorectal cancer and is not recommended. Dif-ferent recommendations apply to women at increased risk and at high risk.

Sexually Transmitted Diseases

Appropriate STD screening in nonpregnant women de-pends on the age of the patient and the assessment of risk factors (Box 2.3). Because of the risk that STDs pose in pregnancy, pregnant women are routinely screened for syphilis, HIV, chlamydia, and gonorrhea.