Papanicolaou smear screening interval and risk of cervical cancer

Article Abstract:

Abnormalities of the cervix (the "neck" of the uterus) associated with cervical cancer can be diagnosed with the Papanicolaou (Pap) smear, a test performed by gynecologists at regular intervals. The use of this test has led to dramatic reductions in the occurrence of cervical cancer. The effects of different intervals between Pap smears on the rate of cervical cancer occurrence, however, have not been systematically investigated. This was explored in a study of 92 women in Washington state who had been diagnosed as having invasive cervical cancer (an advanced form of the disease). In telephone interviews, the women ("cases") were asked to recall the number of Papanicolaou smears they had had in each decade of life; from these data, the number of total smears and the average screening interval were estimated. Age-matched controls (178) were selected randomly, and provided similar information. Comparisons between cases and controls indicated that cases had more risk factors, including earlier age at first sexual intercourse, more sexual partners, and lower educational levels. The longer the interval between Pap smears, the greater the proportion of women with cervical cancer, such that the risk for women who had not undergone testing during a 10-year period was more than six times that for women who had annual smears taken. Even at shorter intervals, there were differences: women screened every three years had a twofold greater likelihood of developing cervical cancer than those screened annually. Screening every two years, instead of every year, did not increase the risk. These effects were true for squamous cell cervical cancer, but not for non-squamous-cell cervical cancer. Current recommendations by The American College of Obstetricians and Gynecologists and the American Cancer Society call for Pap smear screening every one to three years. The results suggest that a three-year interval may substantially increase the risk of developing squamous cell cervical cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Testing, Women, Women's health

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From Papanicolaou to Bethesda: the rationale for a new cervical cytologic classification

Article Abstract:

The Bethesda System is a scheme for classifying results of microscopic examination of cells in the cervix and vagina. The cytology, namely the development, structure, and function of cells, of cervical and vaginal cells was previously classified by the results of the Papanicolaou ('Pap') smear. The Pap test screens for cancer cells and involves obtaining samples of cells from the cervix and vagina during a routine pelvic examination. The cells are stained and examined microscopically, and findings are grouped into numerical Papanicolaou class designations. The Bethesda System eliminates the confusing numerical Papanicolaou class designations, evaluates the adequacy of the specimen used in diagnosis, and uses more specific diagnostic terms, thereby improving communication between the cytopathologist, who determines the cytology, and the clinician, who cares for the patient. Squamous epithelial lesions, or disorders of the flat type of epithelial cells that line the outer surface of skin or mucous membrane, are grouped into: (1) atypical or unusual squamous cells; (2) squamous intraepithelial lesions (SIL); and (3) squamous cell carcinoma. Cell changes caused by infection with human papillomavirus are grouped together with stage 1 of cervical intraepithelial neoplasia (CIN 1) in the category of low-grade SIL, because of similarities in physical, behavioral, and viral-related features of these two disorders. Stage II and III CIN lesions are grouped together in the high-grade SIL category. Atypical squamous cells exhibit features that cannot be considered benign or similar to those of SIL. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Analysis, Cytology, Nosology

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Screening for cervical cancer in emergency centers and sexually transmitted disease clinics

Article Abstract:

Low-income women are at a particularly high risk for developing cervical cancer. Current cervical cancer screening methods such as a Pap test can diagnose cervical cancer in its early stages, but indigent women lack the routine medical care that provides cervical cancer screening tests. However, many low-income women have been given medical care in the five years preceding the diagnosis of cervical cancer, often at emergency centers and clinics providing treatment for sexually transmitted diseases. Many of these places do not have routinely provide cervical cancer screening. Out of the 11 sexually transmitted disease clinics surveyed, fewer than five percent of the patients are given a Pap test at the time of a pelvic examination. If screening methods are to be successful and cost effective, populations at particular risk must be reached and screened. It is suggested that protocols be developed that screen low-income women for cervical cancer while they attend sexually transmitted disease health clinics and emergency centers. (Consumer Summary produced by Reliance Medical Information, Inc.)

Women's health services

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