Tamizaje Del Cancer Cervical

|Cervical Cancer Screening and Updated Pap Guidelines |[pic] |
|Primary Care: Clinics in Office Practice - Volume 36, Issue 1 (March 2009)  -  Copyright © 2009 W. B. Saunders Company | |
| -  About This Clinic ||
|DOI: 10.1016/j.pop.2008.10.008 | |

Cervical Cancer Screening and Updated Pap Guidelines

Johanna B. Warren, MDa,∗[pic] 
Heidi Gullett, MD, MPHb 
Valerie J. King, MD, MPHa 

[pic]
a  Department of Family Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road,Portland, OR 97239-3098, USA 
b  Dayspring Family Health Center, 550 Sunset Trail, Jellico, TN 37762, USA
[pic]
|* Corresponding author. |

[pic]
|E-mail address:  warrejoh@ohsu.edu |

PII S0095-4543(08)00104-8
[pic]

 

Cervical cancer and its dysplasia precursors account for significant morbidity and mortality inwomen worldwide. Human papillomavirus infection is common, preventable, and now widely accepted as the causative agent with oncogenic potential in the development of cervical cancer. Screening via Papanicolaou testing is critical, and interpretation of test results with knowledge of patient risk factors is imperative. Many evidence-based guidelines for screening, interpretation, and management havebeen developed and are widely available for use.

[pic]

|Keywords |
|    |Cervical cancer |    |
|    |Screening |    |
|    |Pap testing |    |
|    |HPV |    |
|    |Dysplasia |    |
|    |Guidelines |    |
|    |Abnormal pap |    |

Epidemiology

Worldwide, cervical cancer accounts for 10% ofall cancers, ranking as the third most commonly diagnosed neoplasm.[1] Among developing countries, cervical cancer accounts for 15% of all cancers and ranks second in incidence.[1] High-risk areas worldwide include South America, East and South Africa, and India.[1] In the United States, cervical cancer no longer is the leading cause of cancer deaths for women largely as a result of aggressivecervical dysplasia screening.[2] Cervical cancer still remains, however, an important neoplasm and results in significant mortality for many American women each year.[2] In the United States, more than 10,000 new cases of cervical cancer are diagnosed yearly with more than 3700 deaths per year attributed to the disease.[3] Disparities remain among Hispanic and African American populations within theUnited States with regard to cervical cancer incidence and mortality.[4] These invasive cancers and deaths are preventable with appropriate screening.

Human papilloma virus (HPV) infections are common with nearly 20 million Americans currently infected and greater than 50% of all sexually active adults infected at some point in their lifetime.[5] Approximately 6.2 million Americans becomeinfected with HPV annually.[5] These infections may resolve spontaneously or may progress to clinically apparent infection, manifesting most notably as cervical dysplasia that can progress to cancer and more common benign genital wart infections.

Pathophysiology

The normal cervix is comprised of different epithelial cell types, and the pathophysiology of cervical cancer depends on anunderstanding of the origin and behavior of these cell types and an appreciation of HPV as a causative infectious agent. The midcervical canal to upper cervix typically is comprised of mucus-secreting columnar epithelium, originating embryologically from the invaginating müllerian ducts.[6] There is little neoplastic potential for this cell type. Lower in the female genital tract, the vagina and distal...