Cervical cancer is largely preventable,
yet according to the American Cancer Society, an estimated
13,000 new cases of invasive cervical cancer will
be diagnosed in 2002 and about 4,100 women will die
of the disease.1 The good news is that cervical cancer
is preventable and curable if it is detected early;
in fact, the occurrence of deaths from cervical cancer
has declined significantly over the last 20 to 30
years
Cervical cancer rates are higher among
older women; however, cervical intraepithelial neoplasia
(or CIN), the precursor lesion to cervical cancer,
most often occurs among young women. Screening women
using the Papanicolaou (Pap) test is an important
strategy that can prevent cervical cancer from developing
most of the time.
Minority populations and persons of
low socioeconomic status are affected disproportionately
as well. For more information on cervical cancer and
specific populations
Cervical Cancer and Specific Populations
Studies that have identified risk factors associated
with cervical cancer have shown that cervical cancer
is closely linked to
failure to receive regular Pap test
screening
human papillomavirus (HPV) infection
certain sexual behaviors (see paragraph below)
immunosuppressive disorders such as HIV/AIDS
Experts agree that infection with certain strains
of the HPV is one of the strongest risk factors for
cervical cancer. The sexual behaviors specifically
associated with greater risk are intercourse at an
early age, multiple male sexual partners, and sex
with a male partner who has had multiple sexual partners.
Experts also agree that one of the most important
things women can do to reduce their risk of cervical
cancer is to receive regular screening with a Pap
test.
Bethesda 2001 updates the earlier
Bethesda System, first published in 1989 and revised
in 1991. The 2001 version reflects the most current
knowledge about the biology of Pap test abnormalities
and addresses new screening technologies that appeared
in the past decade. The 2001 Bethesda System does
not itself include guidelines for managing these abnormalities.
However, it serves as the basis for new management
guidelines that appear in companion articles (i.e.,
2001 Consensus Guidelines for the Management of Women
With Cervical Cytological Abnormalities and 2001 Bethesda
System: Terminology for Reporting Results of Cervical
Cytology) in the Journal of the American Medical Association,
Volume 287, No. 16, April 24, 2002. The articles can
be accessed at the following Web site: http://jama.ama-assn.org/.*
The guidelines were developed under the sponsorship
of the American Society for Colposcopy and Cervical
Pathology (ASCCP) in tandem with the 2001 Bethesda
System. For a additional information, please see links
below.
The U.S. Department of Health and
Human Services has in place an independent panel of
experts in primary care and disease prevention called
the U.S. Preventive Services Task Force (1996). This
task force systematically reviews the evidence of
effectiveness and develops recommendations for clinical
preventive services. Currently, the task force recommends
routine screening for cervical cancer for all women
who are or have been sexually active and who have
a cervix:
Pap testing should begin with the
onset of sexual activity.
Pap testing should be repeated at least every 3 years.
There is insufficient evidence to recommend for or
against an upper age limit for Pap testing, but recommendations
can be made on other grounds to discontinue regular
testing after age 65 in women who have had regular
previous screenings in which the smears have been
consistently normal.
There is insufficient evidence to
recommend for or against routine screening with cervicography,
routine screening with colposcopy, and screening for
human papilloma virus infection, although recommendations
against such screening can be made on other grounds.
Many organizations, including the
American Cancer Society, National Cancer Institute,
American College of Obstetricians and Gynecologists,
American Medical Association, American Academy of
Family Physicians, and others also recommend that
Pap testing should
begin annually at the onset of sexual activity
or at age 18 and
continue less frequently at the discretion of the
doctor and patient after three or more annual tests
have been normal.
Women who are past menopause (change
of life) still need to have regular Pap tests. However,
women who have undergone a hysterectomy in which the
cervix was removed do not require Pap testing, unless
the hysterectomy was performed because of cervical
cancer or its precursors.
1Source: Cancer Facts and Figures
2002, American Cancer Society, 2002.
