Potential risks of treatment of high-grade CIN
Local ablation or excision of the transformation zone has been highly successful in treating high-grade CIN and greatly reduces the risk of progression to invasive carcinoma but it is not itself without risk (Kyrgiou 2014). It is probable that the increase in second trimester miscarriages due to premature rupture of membranes reported after excision biopsy […]
Uses of HPV testing in triage of cervical cytology
Uses of HPV testing alongside cytology Triage of ASC-US and/or LSIL cytology Test of cure after treatment of high-grade CIN Resolution of uncertainties Primary HPV testing or co-testin The principles of all these methods alongside cytology are similar: HPV is more sensitive than cytology for CIN2+ Early detection of CIN2 is not an end […]
Measurement of accuracy
Measurement of accuracy Measurement of accuracy of screening combines sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of a positive test with respect to a positive outcome (Figure 5.5). The following factors must be considered when assessing measurements of accuracy. The nature of the positive and non-positive test for any given circumstance […]
Aetiology of cervical cancer
It is now known that risk factors for cervical cancer are closely related to the persistence of high-risk types of human papillomavirus (HPV) [Walboomers et al. 1999; Li et al. 2011]. Infection by this ubiquitous family of viruses is not the only cause of cervical cancer: its effects must be considered in the context of […]
1. Introduction and an overview of the evolution of the Pap smear to cervical cancer screening as it is today
These chapters of the website were primarily designed for Cytotechnologists and Pathologists (trainee and practicing) who regularly examine cervical cytological preparations The chapters are also designed for Histopathologists Gynaecologists General practitioners Nurse practitioners All these professional groups could benefit from the chapters that explain the effectiveness and limitations of cervical cancer screening as […]
Mechanisms of HPV and other risk factors in oncogenesis
Figure 3.5. Mechanism of HPV and other risk factors in development of cervical cancer (Figure 4 from zur Hausen 2002) The key proteins coded by HPV DNA HPV DNA is 6800-8000 base pairs long, which when translated, codes for 8 Genes. The genes are broken down in to early and late phase, indicating which […]
6. The effect of screening on incidence and mortality
The effect of screening on incidence and mortality of carcinoma of the uterine cervix is difficult to establish because there was no randomised trial before it was started. In some countries screening has been in place for more than 50 years although it may have been poorly organised in the past, or more recently organised […]
Evolution of the Pap smear to cervical cancer screening today
The cervical smear test was developed by Dr George Papanicolaou, an American anatomist who was born and studied in Greece. He was engaged in research into the effect of ovarian hormones on the epithelium of the female genital tract. In 1926, Dr Papanicolaou reported that tumour cells could be seen in vaginal secretions of women […]
References
Bray F, Loos AH, McCarron P et al. (2005). Trends in cervical squamous cell carcinoma incidence in 13 European countries: changing risk and the effects of screening. Cancer Epidemiol Biomarkers Prev 14:677-86. Chaturvedi AK, Engels EA, Pfieffer RM et al. (2011). Human papillomavirus and rising oropharyngeal cancer incidence in the Unites States. J Clin Oncol […]
2. Anatomy, histology and function of the uterine cervix
The uterine cervix is the narrow inferior segment of the uterus, which projects into the vaginal cavity. It is a fibromuscular organ lined by a mucous membrane and measures approximately 3cm in length and 2.5cm in diameter. The cervix is continuous at its superior margins with the body of the uterus and at its inferior margins […]