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Cervical cancer - Highlights

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of cervical cancer.

Alternative Names

Dysplasia; Human papillomas virus; Pap smear

Highlights:

Cervical Cancer and Human Papilloma Virus (HPV)

The human papilloma virus (HPV) is the main cause and risk factor of cervical cancer. HPV, which also causes genital warts, is spread primarily through sexual contact. About half of all sexually active young women become infected with the virus, but only 10% remain infected for more than 5 years.

The risk for cervical cancer is highest for women who have persistent long-term infection with one of the two high-risk strains of HPV. Half of all cervical cancer diagnoses occur in women ages 35 - 55.

HPV Vaccine

The HPV vaccine Gardasil is approved to prevent (not treat) cervical cancer in girls and women ages 9 - 26. The vaccine protects against HPV strains that cause most cases of cervical cancer.

Pap Smear Screening

Regular Pap tests are the best way to ensure that cervical cancer is caught in its earliest stage before developing into invasive cancer.

Women should begin to have Pap tests within 3 years of first becoming sexually active or at age 21 (whichever comes first)
Women under age 30 should have an annual Pap test
Women age 30 and older can have a Pap test every 2 - 3 years or a Pap test plus HPV test once every 3 years, providing their previous tests were normal
Women over age 65 may no longer need routine screening if they have few or no risk factors
Women who have had a Pap test with abnormal results may need more frequent screening

HPV Testing

The HPV DNA test is useful for:

Women over age 30. (HPV testing is not helpful for younger women as the virus usually goes away on its own.)
Women of any age with slightly abnormal Pap test results. For these women, the HPV DNA test can help determine if more tests, or treatment, are needed.

Resources

www.cancer.gov -- National Cancer Institute
www.cancer.org -- American Cancer Society
www.acog.org -- American College of Obstetricians and Gynecologists
www.ashastd.org -- American Social Health Association
www.nccc-online.org -- National Cervical Cancer Coalition
www.cervicalcancercampaign.org -- Cervical Cancer Public Education Campaign
www.thegcf.org -- Gynecologic Cancer Foundation
www.wcn.org -- Women's Cancer Network
www.cancer.net -- Cancer.Net

References

Committee on Infectious Diseases. Prevention of human papillomavirus infection: provisional recommendations for immunization of girls and women with quadrivalent human papillomavirus vaccine. Pediatrics. 2007 Sep;120(3):666-8.

Dunne EF, Unger ER, Sternberg M, McQuillan G, Swan DC, Patel SS, et al. Prevalence of HPV infection among females in the United States. JAMA. 2007 Feb 28;297(8):813-9.

FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007 May 10;356(19):1915-27.

Garland SM, Hernandez-Avila M, Wheeler CM, Perez G, Harper DM, Leodolter S, et al. Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N Engl J Med. 2007 May 10;356(19):1928-43.

Hildesheim A, Herrero R, Wacholder S, Rodriguez AC, Solomon D, Bratti MC, et al. Effect of human papillomavirus 16/18 L1 viruslike particle vaccine among young women with preexisting infection: a randomized trial. JAMA. 2007 Aug 15;298(7):743-53.

Huang CM. Human papillomavirus and vaccination. Mayo Clin Proc. 2008;83(6):701-6.

Hunter MI, Monk BJ and Tewari KS. Cervical neoplasia in pregnancy. Part 1: screening and management of preinvasive disease. Am J Obstet Gynecol. 2008;199(1):3-9.

Hunter MI, Tewari K and Monk BJ. Cervical neoplasia in pregnancy. Part 2: current treatment of invasive disease. Am J Obstet Gynecol. 2008;199(1):10-8.

Long HJ 3rd, Laack NN and Gostout BS. Prevention, diagnosis, and treatment of cervical cancer. Mayo Clin Proc. 2007;82(12):1566-74.

Markowitz LE, Dunne EF, Saraiya M, Lawson HW, Chesson H, Unger ER; Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices (ACIP). Quadrivalent human papillomavirus vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2007 Mar 23;56(RR-2):1-24.

Mayrand MH, Duarte-Franco E, Rodrigues I, Walter SD, Hanley J, Ferenczy A, et al. Human papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. N Engl J Med. 2007;357(16): 1579-88.

Naucler P, Ryd W, Tornberg S, Strand A, Wadell G, Elfgren K, et al. Human papillomavirus and Papanicolaou tests to screen for cervical cancer. N Engl J Med. 2007;357(16):1589-97.

Ronco G, Cuzick J, Pierotti P, Cariaggi MP, Dalla Palma P, Naldoni C, et al. Accuracy of liquid based versus conventional cytology: overall results of new technologies for cervical cancer screening: randomised controlled trial. BMJ. 2007 Jul 7;335(7609):28. Epub 2007 May 21.

Saslow D, Castle PE, Cox JT, Davey DD, Einstein MH, Ferris DG, et al. American Cancer Society Guideline for human papillomavirus (HPV) vaccine use to prevent cervical cancer and its precursors. CA Cancer J Clin. 2007 Jan-Feb;57(1):7-28.

Wright TC Jr., Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ and Solomon D. 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Am J Obstet Gynecol. 2007;197(4): 346-55.

Wright TC Jr., Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ and Solomon D. 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ. Am J Obstet Gynecol. 2007;197(4): 340-5.

Reviewed last on: 10/6/2008
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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