Cervical cancer update: The latest on screening & management
Here are updated guidelines for prevention, testing, and treatment. Elimination of causative HPV continues to hold center stage in the global effort to curb disease.
PRACTICE RECOMMENDATIONS
› Encourage eligible patients to be vaccinated against human papillomavirus (HPV) because the vaccine is highly effective for preventing cervical dysplasia, especially when given to patients previously unexposed to the virus. A
› Screen for cervical disease with either cytology plus HPV testing or primary HPV testing with secondary triage for cytology; both protocols are more accurate than screening with cervical cytology alone, and allow you to widen the screening interval. A
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Ablative treatments are cryotherapy, CO2 laser ablation, and thermal ablation. Ablative therapy has the advantage of presenting less risk of adverse obstetric outcomes (eg, preterm birth); it can be used if the indication for therapy is:
- CIN1 or CIN2 and HPV type 16 or 18 positivity
- concordant cytology and histology
- satisfactory colposcopy
- negative endocervical curettage.
The most common ablative treatment is liquid nitrogen applied to a metal tip under local anesthesia.
Hysterectomy can be considered for patients with recurrent CIN2+ who have completed childbearing or for whom repeat excision is infeasible (eg, scarring or a short cervix), or both.
Cost, availability, and convenience might play a role in decision-making with regard to the treatment choice for cancer precursors.
Is care after treatment called for? Patients who continue to be at increased risk of (and thus mortality from) cervical and vaginal cancer require enhanced surveillance. The risk of cancer is more than triple for patients who were given their diagnosis, and treated, when they were > 60 years, compared to patients treated in their 30s.1 The excess period of risk covers at least 25 years after treatment, even among patients who have had 3 posttreatment screenings.
Continue to: Persistent HPV positivity...
