Patient Care Hematology & Oncology - October 2007 - (Page 16)

I Cervical cancer guidelines Article at a glance I I I I I There is almost no risk of developing cervical cancer within 5 years of the first potential exposure to human papillomavirus (HPV) and very little risk during the subsequent 5 years; cervical cancer is almost nonexistent in adolescents, and continues to be very rare through the early 20s. Screening women for cervical cancer within the first few years of intercourse offers almost no benefit and may create harm, and most low-grade lesions are caused by known oncogenic HPV types and spontaneously regress. The Pap test should not be the sole reason for the onset of gynecologic care. Women who have started having sex should have contraceptive services, screening for sexually transmitted infections, and other indicated preventive health care regardless of their cervical screening status. Both the American Cancer Society (ACS) and the American College of Obstetricians and Gynecologists (ACOG) recommend that screening intervals can be widened to 2 to 3 years for women aged 30 and older who have had 3 consecutive satisfactory normal Pap results, as these women are at less risk for subsequent detection of cervical intraepithelial neoplasia 2,3+. Both the ACS and ACOG offer the option of extending the interval for women older than 30 by screening with a Pap (conventional or liquid-based cytology) and an HPV test (combined testing); women with negative results on both tests require subsequent screening with this combination no more often than every 3 years. with case studies on how to integrate the guidelines into your practice. When to begin screening Before researchers fully appreciated the absolute role human papillomavirus (HPV) plays in causing cervical cancer, the screening recommendation used to be: Begin cervical screening at the onset of vaginal intercourse or at age 18, whichever came first.3 Because there is almost no risk of developing cervical cancer within 5 years of the first potential exposure to HPV and very little risk during the subse- quent 5 years, cervical cancer is almost nonexistent in adolescents, and it continues to be very rare through the early 20s. From 2000 to 2004, the median age at diagnosis for cervical cancer was 48 years and only 0.1% of all cervical cancers were diagnosed under the age of 20.6 During the same period the median age at death for cancer of the cervix was 57, with no deaths reported in women under the age of 20. In contrast to this very low risk for cervical cancer in young women, the risk for acquiring HPV in the late teens and early 20s is very high. For example, in a study in the United Kingdom, 44% of teens between ages 15 and 19 tested positive for HPV at least once during a 3-year period, and 60% were positive by 5 years.7 Similar results have been found in studies of young women in our own country.8,9 This very high rate of HPV infection results in high rates of minor Papanicolaou (Pap) abnormalities reported as HPV-positive atypical squamous cells of undetermined significance (ASC-US) and as lowgrade squamous intraepithelial lesions (LSIL).10 However, most of these low-grade cytologic changes are transient, disappearing in step with successful immune suppression of the virus that caused them. Most women infected with HPV will have a favorable outcome: a return to an HPV-negative state for that same HPV type within 6 to 12 months of first HPV detection.9 Even when cervical dysplasia is detected in young women, most is low grade (cervical intraepithelial neoplasia Grade 1 [CIN 1]) and most resolves spontaneously. Additionally, when high-grade precancer occurs (CIN Grade 2,3), the time for transit to invasive cancer is usually many years.11 Approximately 70% to more than 90% of high-risk HPV infections in young women will resolve to an HPV-negative state over a period of 2 to 3 years.8,12 Two very important lessons to be learned from these data are that screening women within the first few years of intercourse offers almost no benefit and may create harm, and that most low-grade lesions are caused by 16 PATIENT CARE HEMATOLOGY & ONCOLOGY www.patientcareonline.com http://www.patientcareonline.com

Table of Contents Feed for the Digital Edition of Patient Care Hematology & Oncology - October 2007

Patient Care - Hematology & Oncology - October 2007 Research Digest Contents Information for Authors Medicine in the News Strategies for Bridge Anticoagulation Therapy How to Integrate the New Cervical Cancer Guidelines into Practice Dermatology Case Challenge Clinical Clips Classified Advertising

Patient Care Hematology & Oncology - October 2007

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