DESCRIPTION
· The Papanicolaou (Pap) smear is a screening test for cervical cellular pathology. In many laboratories, automated cervical screening complements the Pap smear or supersedes it.
· Abnormal cervical smear results can range from benign cellular changes to suggestion of invasive cancer.
· System(s) Affected: Reproductive
ALERT
Cervical cancer arises from a sexually transmitted disease (STD) caused by human papilloma virus (HPV) (1)[A].
Geriatric Considerations
Less frequent, except in the unscreened population
Pediatric Considerations
Transient Pap smear abnormalities are very common in adolescents, but exceedingly rare before initiation of sexual activity.
Pregnancy Considerations
Squamous intraepithelial lesions can progress during pregnancy, but often regress postpartum.
GENERAL PREVENTION
· HPV Immunization of girls and women prior to sexual debut
· Delay 1st intercourse beyond early adolescence
· Monogamous relationship for both partners
· Smoking cessation
· Adequate antioxidant-rich food intake has been associated with decreased risk
· Obtain routine Pap smears; HPV changes occur ~3 years after initiation of sexual intercourse
· Use barrier methods of birth control if nonmonogamous relationship
· Discontinue Pap smears after age 65-70 in women with recent normal screening and not otherwise at high risk for cervical cancer
EPIDEMIOLOGY
Predominant age: Can occur at any age
· Incidence of CIN3 peaks between ages 25 and 29; invasive disease peaks 15 years later.
Incidence
· Low-grade squamous intraepithelial lesion ranges from 2-3% of all Pap smears
· High-grade squamous intraepithelial lesion and invasive cancer present on 1% of Pap smears
· Other reactive, reparative, and ASC-US (atypical squamous cells of undetermined significance) results are difficult to assess because of the lack of reporting mechanisms
RISK FACTORS
· Cigarette smoking
· Possible deficiency of antioxidants
· Early age of intercourse
· Multiple sexual partners
· Some correlation to low socioeconomic level
· Intercourse with a high-risk male partner
· Human papilloma virus (HPV) infection
· Immunosuppressed
· Human immunodeficiency virus (HIV) infection (associated with earlier and more rapidly progressive cervical disease)
ETIOLOGY
· HPV DNA is found in virtually all cervical carcinomas and precursor lesions worldwide (2)[C]:
- HPV viral types 16, 18, 31, 35, 45, 51, 52, 56, and 58 are common high-risk or oncogenic virus types for cervical cancer.
- HPV viral types 6, 11, 42, 43, and 44 are considered common low-risk types, and cause genital warts.
· HPV DNA of high-risk viral types is integrated into the human cervical cell DNA.
