CERVICAL SCREENING

Question 1

Cervical Screening

Answer 1

• Done to assess for abnormal cervical cytology: Dysplasia
• Pap smear screen: identify patients with cellular changes at risk for cancer
• Risk factors for cervical cancer
  o Sexual intercourse at an early age
  o Multiple partners over lifetime
  o Age: 40-50
  o Lower socioeconomic status
  o Cigarette smoking
  o Immune deficiency disease (HIV)
• Infection with HPV cause of >95% cancers

Question 2

Obtaining a Pap Smear

Answer 2

• Obtain cells from squamocolumnar junction using cytobrush or broom
• Use spatula or broom for pan-cervical cells
• Conventional method: smear cells on slide and fix
• Newer method: Thinprep
• Thin preps are more accurate but more costly – detect HPV
• Go the same direction when moving around the cervix when getting sample

Question 3

Cervical Cancer Screening Recommendations: ACS, ACOG, USPSTF guidelines

Answer 3

• Start at age 21 years or 3 years after first intercourse
• Women age 21 – 29 should be screened every 3 years
• Women 30 to 65 with 3 consecutive negative pap smears can be screened every 5 years
• Pap yearly if risk factors
• Stop cervical cancer screening at 65 who have 3 or more negative pap smears in a row and no abnormal in the past 10 years.
• Stop pap smears in women regardless of age who have a total hysterectomy (uterus and cervix) for non-cancer reasons as long as they have no history of high grade CIN
  Exceptions to The Rule
• Abnormal pap smear
  o Need annual pap till 2 normal, then follow guidelines
• Hx. Of cervical or uterine cancer
  o Continue screening past 65 till 20 years cancer free
• Hysterectomy
  o No Pap smear unless cancer

Question 4

Classification Systems for Pap smears

Answer 4

• Bethesda system
  o Within Normal Limits
  o Benign Cellular Changes – Reactive/Reparative Changes
• Epithelial cell abnormalities:
  o ASC-US: atypical cells of undetermined significance
  o ASC-H: cannot exclude high-grade lesion
  o LSIL: low-grade, mild dysplasia, CIN 1
  o HSIL: high-grade, mod-severe dysplasia. CIN 2/3
  o CIS: Carcinoma in situ
• Glandular cell abnormalities:
  o AGC: atypical glandular cells
  o AIS: Endocervical adenocarcinoma in situ

Question 5

Treatment Options: Summary of 2006 Algorithms for Women Over 21 Years

Answer 5

• ASC-US
  o Repeat at 6 and 12 months OR
  o HPV DNA Testing
• ASC-H: Colposcopy
• LSIL: Colposcopy if non-pregnant
• HSIL: LEEP or Colposcopy
• AGC: Colposcopy unless Atypical Endometrial cells, then Endometrial Bx

Question 6

HPV Testing

Answer 6

• HPV DNA Test: identifies 13 high risk types
• Used in conjunction with Pap
• Not a substitute for Pap
• Directs follow-up plan if certain pap abnormalities, ie. ASCUS