Importance of CervicalCancer
• • Cervical cancer is a major public health
concern, especially in low-resource settings.
• • Widespread screening has led to a
significant reduction in cervical cancer
incidence and mortality.
• • The mortality rate declined from 2.8 per
100,000 women in 2000 to 2.3 per 100,000
women in 2015.
• • Most cases of cervical cancer occur in
women who have not been adequately
3.
Why Population Screening?
•• Screening helps detect high-grade
precancerous cervical lesions and cervical
cancer at an early stage.
• • Early detection allows for timely
intervention, preventing progression to
invasive cancer.
• • Cervical cancer screening strategies have
proven effective in reducing mortality rates.
• • HPV screening has emerged as a highly
sensitive method for detecting cervical
4.
Epidemiology (Prevalence,
Incidence, Mortality)
•• Cervical cancer is the fourth most common
cancer among women worldwide.
• • In 2018, an estimated 13,240 new cases and
4,170 deaths were reported in the U.S.
• • Higher mortality rates are seen in certain
racial and ethnic groups due to disparities in
screening and treatment.
• • The primary cause of cervical cancer is
persistent infection with high-risk HPV types,
which are transmitted sexually.
5.
Target Population forScreening
• • Women aged 21 to 65 years are the primary
target for cervical cancer screening.
• • Screening is NOT recommended for:
• - Women under 21 years (low risk, high rate
of spontaneous HPV clearance).
• - Women over 65 years with adequate prior
screening and no history of high-grade lesions.
• - Women who have undergone total
hysterectomy for benign reasons.
• • High-risk populations (e.g., women with HIV,
6.
Screening Frequency andMethods
• • Women aged 21-29: Pap smear (cytology)
every 3 years.
• • Women aged 30-65: Three options available:
• - Cytology alone every 3 years.
• - High-risk HPV (hrHPV) testing alone every 5
years.
• - Co-testing (cytology + hrHPV) every 5 years.
• • Screening intervals longer than 3-5 years are
NOT recommended due to the risk of missed
cases.
7.
Benefits and Harmsof Screening
• Benefits of Screening:
• • Reduces incidence and mortality of cervical
cancer.
• • Allows for early detection and treatment of
precancerous lesions.
• • Helps in monitoring the impact of HPV
vaccination programs.
• Harms of Screening:
8.
USPSTF Recommendations for
CervicalCancer Screening
• • Women 21-29 years: Pap smear every 3
years.
• • Women 30-65 years: Three options:
• - Pap smear every 3 years.
• - hrHPV testing every 5 years.
• - Co-testing every 5 years.
• • Women >65 years: Discontinue screening if
prior tests were normal.
• • Women with total hysterectomy (not due to
9.
Special Considerations and
Exemptions
•• Women with prior high-grade lesions or
cervical cancer require extended screening
beyond age 65.
• • Women living with HIV should be screened
more frequently (e.g., Pap smear annually).
• • HPV vaccination does not eliminate the need
for regular screening but may alter future
recommendations.
• • Screening disparities exist among minority
and low-income populations, requiring
10.
Conclusions and Future
Recommendations
•• Cervical cancer screening has been highly
effective in reducing mortality rates.
• • HPV testing may become the preferred
primary screening method in the future.
• • Self-sampling for HPV testing could improve
screening coverage in underserved
populations.
• • Ongoing research is needed to refine
screening strategies in vaccinated populations.
• • Efforts should be made to improve access to
