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Cervical Cancer ScreeningMore Choices in 2019

Educational Objective
To review the various cervical cancer screening options available to women
1 Credit CME

Widespread adoption of population-based screening has been associated with marked decreases in cervical cancer incidence and mortality in the United States over the last few decades. Despite these gains, an estimated 13 240 US women were diagnosed with cervical cancer in 2018, and 4170 died from the disease.1

A large body of consistent evidence implicates infection with high-risk types of human papillomavirus (hrHPV) as the causative agent in cervical cancer. These infections are common, occurring in the majority of sexually active women over their lifetime.2 While most infections resolve without clinical consequence over a period of several years, persistent infections can lead to high-grade precancerous cervical lesions (such as cervical intraepithelial neoplasia [CIN] grades 2 and 3) that can progress to cervical cancer. Approximately 30% of CIN grade 3 lesions progress to invasive cancer over a 30-year period.2 This slow progression allows many opportunities for these lesions to be detected and treated, thereby disrupting the trajectory to cancer.

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Article Information

Corresponding Author: George F. Sawaya, MD, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 550 16th St, Seventh Floor, San Francisco, CA 94143 (george.sawaya@ucsf.edu).

Conflict of Interest Disclosures: Dr Sawaya reported receipt of grants from the National Cancer Institute (NCI) during the conduct of the study. Dr Smith-McCune reported receipt of grants from the National Institutes of Health (NIH) during the conduct of the study. Dr Kuppermann reported grants from NIH/NCI during the conduct of the study.

References
2.
Agency for Healthcare Research and Quality.  Evidence synthesis No. 158: screening for cervical cancer with high-risk human papillomavirus testing: a systematic evidence review for the US Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/Home/GetFileByID/3279. Accessed April 13, 2019.
3.
Curry  SJ, Krist  AH, Owens  DK,  et al; US Preventive Services Task Force.  Screening for cervical cancer: US Preventive Services Task Force recommendation statement.  JAMA. 2018;320(7):674-686. doi:10.1001/jama.2018.10897PubMedGoogle ScholarCrossref
4.
Huh  WK, Ault  KA, Chelmow  D,  et al.  Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance.  Obstet Gynecol. 2015;125(2):330-337. doi:10.1097/AOG.0000000000000669PubMedGoogle ScholarCrossref
5.
 Practice bulletin No. 168 summary: cervical cancer screening and prevention.  Obstet Gynecol. 2016;128(4):923-925. doi:10.1097/AOG.0000000000001699PubMedGoogle ScholarCrossref
6.
Saslow  D, Solomon  D, Lawson  HW,  et al; ACS-ASCCP-ASCP Cervical Cancer Guideline Committee.  American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer.  CA Cancer J Clin. 2012;62(3):147-172. doi:10.3322/caac.21139PubMedGoogle ScholarCrossref
7.
Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents.  Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. https://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. Accessed March 20, 2019.
8.
Massad  LS, Einstein  MH, Huh  WK,  et al; 2012 ASCCP Consensus Guidelines Conference.  2012 Updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors.  Obstet Gynecol. 2013;121(4):829-846. doi:10.1097/AOG.0b013e3182883a34PubMedGoogle ScholarCrossref
9.
Kuppermann  M, Sawaya  GF.  Shared decision-making: easy to evoke, challenging to implement.  JAMA Intern Med. 2015;175(2):167-168. doi:10.1001/jamainternmed.2014.4606PubMedGoogle ScholarCrossref
10.
Sawaya  GF, Sansted  E, Alarid-Escudero  F,  et al.  Estimated quality of life and economic outcomes associated with 12 cervical cancer screening strategies: a cost-effectiveness analysis.  JAMA Intern Med. doi:10.1001/jamainternmed.2019.0299Google Scholar
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