The fallacy of the screening interval for cervical smears

Article Abstract:

The ability to detect cervical cancer at an early stage has led to improved rates of survival. Improvements in cell analysis and other factors that enhanced the acceptance of annual gynecologic examinations have contributed to this success. Recommendations for annual analysis of cervical cells, using the Papanicolaou (Pap) smear, were altered in 1980 when the American Cancer Society suggested that triennial (every three years) smears were acceptable for women who had normal smears in two consecutive years. This decision, based on economics, relied on data from carefully controlled, large screening programs, performed in chiefly European countries (which have centralized, highly organized medical systems). The new guideline was not accepted by physicians in the US, and it was revised; after three normal consecutive smears, less frequent Pap smears were recommended, according to a physician's discretion. In spite of the effectiveness of and emphasis on cervical screening throughout the medical community, cervical cancer is still a chief cancer of reproductive organs among low-income women. The relevance of the current Pap smear guidelines for 174 inner-city women with cervical cancer was evaluated. Eighty-seven percent (151 women) reported receiving medical care within five years, and 68 reported having a Pap smear during that time. Among 83 patients for whom complete records were available, 89 percent of the patient reports and medical records agreed, but there was a tendency among the remainder to over-report cervical smears, an expected finding for this socially approved behavior. Among 50 women with recorded Pap smears, 76 percent knew the correct results. The severity of the cancer stage was strongly related to the lapse of time since the last cervical smear. Cervical tumors tended to be more advanced among women who had normal smears within the previous three years, than among women who had recent abnormal Pap smears. The results suggest that patients' reporting of recent previous Pap smears, even with normal results, may not be sufficient to justify discontinuation of annual cervical smears. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Standards, Evaluation, Diagnosis, Medical screening, Health screening, Medical protocols

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Colposcopic evaluation of human immunodeficiency virus-seropositive women

Article Abstract:

Immunodeficiency in humans, such as that caused by HIV infection, increases the risk for developing abnormal growths (neoplasia) and cancers. Cervical neoplasia is frequently seen in women with decreased immune function. This study examined the effects HIV infection on tissues in the cervix. (HIV causes AIDS.) Two procedures were compared: colposcopy, which uses a magnifying lens to examine the cervix and obtain tissue for biopsy; and cervical cytology (more commonly known as the Pap smear), which scrapes cells from the cervix for laboratory examination. The number of T cells was measured as an indication of immune system status. The examinations were performed on 32 HIV-infected women. Results showed that all but one woman had an identifiable risk factor for HIV infection. A majority had risk factors for developing cervical neoplasia, including smoking (56 percent), intercourse before age 17 (59 percent), and more than three sexual partners (75 percent). Cytology results were negative for 25 of the women (78 percent) and positive for cervical intraepithelial neoplasia (CIN) for one woman. In contrast, colposcopically directed biopsy found CIN in 13 (41 percent) of the women. All five patients with AIDS had CIN, compared with only 30 percent of the women who had not yet developed AIDS. Patients with AIDS and CIN had lower CD4 T cell counts than the other women with CIN. In fact, HIV-infected women with CIN had lower CD4 T cell counts that the women who did not have CIN. These results indicate that HIV-infected women have a greatly increased risk for CIN. This risk increases as CD4 counts decrease and when AIDS develops. Cytology is not highly effective in diagnosing CIN in these patients and regular colposcopic examination of HIV-infected women is recommended. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Complications and side effects, Medical examination, Cervix uteri, T cells, AIDS (Disease), Immunodeficiency, Cervix diseases, Colposcopy

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Is HIV infection a risk factor for advanced cervical cancer?

Article Abstract:

HIV infection appears not to be associated with increased risk of cervical cancer. Researchers compared 28 HIV-infected women and 132 HIV-negative women with invasive cervical cancer. Advanced disease was found in 78% of HIV patients and 55% of HIV-negative patients with cervical cancer. HIV infection was associated with high-risk sexual behavior or substance abuse in both groups. Duration of symptoms and lack of a recent cervical Pap test, rather than HIV infection, were most predictive of advanced cervical cancer.

Health aspects, Diseases, HIV patients

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