Cytological Screening

We made a comprehensive literature search that included the Cochrane Register of Diagnostic Test Accuracy Studies; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE (through PubMed), and EMBASE (last search 6 January 2011). Selected journals likely to contain relevant papers were handsearched from 1992 to 2010 (December). We also searched CERVIX, the bibliographic database of the Unit of Cancer Epidemiology at the Scientific Institute of Public Health (Brussels, Belgium) which contains more than 20,000 references on cervical cancer.More recent searches, up to December 2012, targeted reports on the accuracy of triage of ASCUS or LSIL with other HPV DNA assays, or HPV RNA assays and other molecular markers. These searches will be used for new Cochrane reviews as well as for updates of the current review.

What is the Human Papillomavirus? Commonly known as HPV, it is an infection that spreads through sexual contact. There are over one hundred different types of HPV; several types cause genital warts, while other high risk strands can lead to cancer of the cervix, anus, vagina, and penis. Because HPV is often asymptomatic, many people are unaware of their infection status, and thus, their potential for transmitting the virus to a sexual partner. The significance of the Human Papillomavirus is that fifty percent of Americans who are sexually active will contract it within their lives, and at any given point there are twenty million Americans already infected with it (“By the numbers: HPV Vaccine”).

You may be screened for cervical cancer more often if you have risk factors for cervical cancer

The U.S. Preventative Services Task Force (USPSTF) recommends cervical cancer screening with cytology testing (also known as a Pap Smear) every three years in women ages 21 to 65 (U.S. Preventative Services Task Force [USPSTF], 2016a). The USPSTF has graded this recommendation with an “A” indicating that they have a high level of certainty that the screening will prove to be beneficial, rather than harmful to the patient (USPSTF, 2016a). However, if this patient would prefer to receive cervical cancer screening every five years, the USPSTF also has a high level of certainty that this will prove to beneficial rather than harmful if human papillomavirus (HPV) and cytology are both performed during this screening (USPSTF, 2016a). The

Cervical cancer is when there are malignant cells present in the cervix; it is developed in the lining of the cervix. A cervix is a narrow opening located at the bottom of the uterus that leads into the vagina. Cervical cancer mostly affects women between the ages of 40 and 55. This cancer can be prevented by screening for precancerous cells, and it can also be cured if it is detected at an early stage. Over the past few decades the number of cervical cancer cases has declined dramatically due to a more widespread screening of the disease. Today, it is estimated that 10,000 new

Cervical Cancer Early Detection Program Journal of Women’s Health 20(10):1479-84 doi: 10.1089/jwh.2010.2530. Epub 2011 Jul 20

The most common sexually transmitted infection (STI) is human papillomavirus (HPV) (CDC, 2013). Over half of sexually activity people will become infected with HPV at some point in their lifetime (National Cancer Institute, 2012). HPV can fall into two categories: low-risk HPV and high-risk HPV (National Cancer Institute, 2012). Low-risk HPV, also known as HPV types 6 and 11, cause about 90% of genital warts (National Cancer Institute, 2012). High-risk HPV, also known as HPV types 16 and 18, causes about 70% of cervical cancer (National Cancer Institute, 2012).

Prophylactic vaccination against high risk human papilloma virus 16 and 18 represents an exciting means of protection against HPV related malignancy. However, this strategy alone, even if there is a level of cross protection against other oncogenic viruses, cannot completely prevent cervical cancer. In some countries cervical screening programs have reduced the incidence of invasive cervical cancer by up to 80 percent although this decline has now reached a plateau with current cancers occurring in patients who have failed to attend for screening or where the sensitivity of the tests have proved inadequate. Cervical screening is inevitably associated with significant anxiety for the many women who require investigation and treatment following abnormal cervical cytology. However, it is vitally important to stress the need for continued cervical screening to complement vaccination in order to optimize prevention in vaccines and prevent cervical cancer in older women where the value of vaccination is currently unclear. It is likely that vaccination will ultimately change the natural history of HPV disease by reducing the influence of the highly oncogenic types HPV 16 and 18. In the long term this is likely to lead to an increase in recommended screening intervals. HPV vaccination may also reduce

The symptoms of cervical cancer are not always obvious thus the introduction of NHS cervical screening programme. The aim of the NHS Cervical Screening Programme is prevent the number women who die from cervical cancer each year due to not having early diagnoses. Since the introduction of the programme, a report was done between the NHS Cervical Screening Programme and Trent Cancer Registry it found that “Incidence and mortality rates in England have fallen considerably over the past 20 years. During this period, incidence rates decreased by over a third and mortality rates reduced by 60%. Survival, following a diagnosis of cervical cancer has improved in England since the 1980’s from the 83% to 88%”. (NHS, 2012, pp. P10-11).

HPV is the number one sexually transmitted infection (STI) in the United States, and anyone who is sexually active is at risk of contracting the virus. HPV is transmitted through intimate skin-to-skin contact with someone who has the virus, and it is so common that most all sexually active men and women encounter a strain without ever knowing they’re infected (CDC). There are many strains of the HPV virus, some of which don’t cause cervical cancer. To help understand and classify the types of HPV, the terms low-risk and high-risk HPV are used. Some

With each new screening testing procedure comes the social, ethical and scientific implication of the screening process. The social aspect of the screening is the risk of being stigmatized, for example it was believed that if you go to the hospital to get a pap smear you are sexually promiscuous. However, pap smear is a screening testing for cervical cancer, it is used to analysis the existence of precancerous or cancerous cells in the cervix. It is an uncomplicated, brief and necessary screening test recommended for every woman after the age of 21 or is sexually active. Pap smear is screening procedure for cancer which satisfy the social, ethical and scientific aspects of screening. Although

Cervical cancer is one of the highly popular disease for the women. Different programmes has been made up to fight against this deadly disease. New Zealand has one of the best screening programmes in the world. The establishment of National Cervical Cancer Screening Programme in NZ in 1990 had reduced a significant number of 60% of women who develop cervical cancer and who die from it since it was built. More than 1 million New Zealander women are enrolled in this programme and 95 % are eligible. The Cervical Cancer screening programme aims to; informing women about the importance of having the cervical screening tests; promoting cervical screening tests on a regular basis to women aged 20–70; ensuring high-quality and culturally appropriate services; supporting women with abnormal tests; ensuring there is regular monitoring to see that the goals of the programme are being met. The NCSP also acknowledges the importance of the Treaty of Waitangi in providing a screening programme that is successful for all New Zealand women.

Among the many arguments for mandatory HPV vaccination, the foremost is that it is an important medical achievement and a major public health milestone. This vaccine has proven to be one-hundred percent effective in preventing the 4 HPV strains that are responsible for seventy percent of cervical cancers and ninety percent of genital warts. In addition, no serious side effects have been identified. Because this vaccine is a preventive measure, administration before onset of sexual activity is ideal; however, even females who have been sexually active can still benefit from this vaccination (Perkins et al., 2010). Nationally and internationally, the HPV vaccine will significantly reduce disease burden by reducing monetary and psychological costs of invasive procedures that remove precancerous and cancerous lesions. By combining vaccination with routine Pap smear screening, these public health efforts have the remarkable opportunity to eradicate cervical cancer (Ramet et al., 2011).

Visual inspection with acetic acid (VIA) is a simple, inexpensive test, with moderate sensitivity and specificity for screening that can be combined with simple treatment procedures for early cervical lesions (59). Visual inspectionis direct visualization of the cervix after application of a solution of either acetic acid 3–5% (VIA) or Lugol’s iodine (VILI). A result is obtained immediately and treatment can be performed at the same setting. In visual inspection with acetic acid (VIA), CIN lesions will turn white for a few minutes after application of acetic acid. The effect of acetic acid depends on the amount of nuclear proteins, and cytokeratins present in the cervical epithelium, which increases in CIN. (60) Scaling up and inclusion of VIA-based

Three separate randomized controlled trials for cervical screening have been conducted among Indian women of the