Cervical cancer screening

Question 1

Facts

Answer 1

Invasive cervical cancer is a disease for which definite curable premalignant lesions can be identified using a cervical screening test.

The incidence of cervical cancer has decreased significantly through:

• HPV vaccination
• cervical cancer screening
• colposcopy
• colposcopically directed cervical biopsy.

The cervical screening test uses a primary HPV test with partial genotyping.

• If an oncogenic HPV type is detected, a ‘reflex’ liquid-based cytology (LBC) is performed on the cervical sample to guide further management.

Question 2

Screening recommendations

Answer 2

Begin cervical screening at 25 years

• or two years after first sexual intercourse,
• whichever is later

An exit test can be performed at age 70–74 years

Both HPV-vaccinated and non-vaccinated women require screening

Screening applies only to asymptomatic women

Women with postcoital or persistent intermenstrual bleeding require:

• a co–test (both HPV test and diagnostic LBC)
• referral for an appropriate investigation to exclude malignancy

Question 3

The importance of a good specimen

Answer 3

The optimal cervical sample contains:

1. Sufficient mature and metaplastic squamous cells
   * to indicate adequate sampling from the whole of the transformation zone
2. Sufficient endocervical cells

• to indicate that the upper limit of the transformation zone was sampled
• and to provide a sample for screening of adenocarcinoma and its precursors

Question 4

The transformation zone in menopausal women: it is vital that the sample is collected from this zone

Answer 4

Question 5

Results interpretation

Answer 5

HPV not detected:

• –repeat in 5 years

HPV not 16/18 detected:

–negative cytology, possible low-grade intra-epithelial lesion (pLISIL) and definite LSIL, repeat HPV test in 12 months

–high-grade epithelial lesion (HSIL), refer for colposcopy

HPV 16/18 detected:

–all cytology results, refer for colposcopy