This long natural history provides the opportunity for screening to effectively detect this process during the preinvasive phase, thus allowing early treatment and cure. The rate at which invasive cancer develops from CIN is usually slow, measured in years and perhaps decades.
Sequential testing sensitivity specificity question plus#
A further categorization, the Bethesda system, is based on cytologic findings: atypical squamous cells of undetermined significance (ASCUS) or cannot rule out low-grade squamous intraepithelial lesions (LSILs), LSILs (consisting of cytologic atypia and CIN 1), and high-grade squamous intraepithelial lesions (HSILs), primarily CIN 2–3 plus carcinoma in situ. Not all of these lesions progress to invasive cancer many mild and moderate lesions regress. CIN is histologically graded into mild dysplasia (CIN 1), moderate dysplasia (CIN 2), or severe dysplasia (CIN 3). Invasive squamous carcinoma of the cervix results from the progression of preinvasive precursor lesions called cervical intraepithelial neoplasia (CIN), or dysplasia. When corrected for the prevalence of hysterectomy, the mortality rate for Black women is nearly twice the mortality rate for White women. This improvement has been attributed largely to screening with the Papanicolaou (Pap) test. Since the early 2000s, the pace of decline in the death rate decreased by 0.7% per year. Incidence rates have stabilized in the most recent decade. These rates have been improving steadily. In the United States in 2023, it is estimated that 13,960 cases of invasive cervical cancer will be diagnosed and that 4,310 women will die of the disease.
Natural History, Incidence, and Mortality Ronco G, Dillner J, Elfström KM, et al.: Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials.Chen HC, Schiffman M, Lin CY, et al.: Persistence of type-specific human papillomavirus infection and increased long-term risk of cervical cancer.Szarewski A: Cervical screening by visual inspection with acetic acid.Sankaranarayanan R, Nene BM, Shastri SS, et al.: HPV screening for cervical cancer in rural India.Wright TC, Stoler MH, Behrens CM, et al.: Primary cervical cancer screening with human papillomavirus: end of study results from the ATHENA study using HPV as the first-line screening test.Kyrgiou M, Athanasiou A, Paraskevaidi M, et al.: Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis.Preventive Services Task Force recommendation statement. Preventive Services Task Force: Screening for cervical cancer: U.S. Sawaya GF, McConnell KJ, Kulasingam SL, et al.: Risk of cervical cancer associated with extending the interval between cervical-cancer screenings.Sasieni P, Castanon A, Cuzick J: Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data.Study Design: Evidence obtained from a single cohort study.Magnitude of Effect: Regular Pap screening decreases cervix cancer incidence and mortality by at least 80%. Screening is not beneficial in women older than 65 years if they have had a recent history of negative test results. The benefits of screening women younger than 21 years are small because of the low prevalence of lesions that will progress to invasive cancer. Screening With the Papanicolaou (Pap) Test: Benefitsīased on solid evidence, regular screening for cervical cancer with the Pap test in an appropriate population of women reduces mortality from cervical cancer. Other PDQ summaries on Cervical Cancer Prevention, CervicalĬancer Treatment, and Levels of Evidence for Cancer Screening and Prevention Studies are also available. The rest of the summary describes the evidence in more detail. Note: The Overview section summarizes the published evidence on this topic. Screening With the Pap Test and the HPV DNA Test (Cotesting): Harms.Screening With the Pap Test and the HPV DNA Test (Cotesting): Benefits.
Screening With the Human Papillomavirus (HPV) DNA Test: Benefits.Screening With the Papanicolaou (Pap) Test: Benefits.
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