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Cervical Cancer Screening and the Immunosuppressed Patient: the Issues in Screening High-Risk Populations

  • Gynecologic Oncology (C Feltmate, Section Editor)
  • Published:
Current Obstetrics and Gynecology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

While evidence-based guidelines are available for cervical cancer screening in the general population, women at higher risk of persistent HPV infection and cervical cancer are excluded. There is limited evidence to guide screening practices for “high-risk” women, in particular, those who are immunosuppressed.

Recent Findings

Women with immunosuppression demonstrate an increased risk of cervical dysplasia and invasive cervical cancer (ICC) compared to the baseline population. Women with HIV were found to have increased rates of ICC and recurrent dysplasia, compounded by lower CD4 counts. Women with other forms of immune suppression demonstrated variable risk of dysplasia and cancer with the highest risk in transplant recipients and variable risk of dysplasia reported in autoimmune diseases. Data support updated screening guidelines for women with HIV: annual cytology for 3 years, and if screening is negative, increased screening intervals to every 3 years. However, women with HIV and other forms of immunosuppression have been reported to be less compliant with screening guidelines.

Summary

While there is high-quality data to support screening intervals for women with HIV, we were not able to identify data to guide modality and interval of screening in other types of immune compromise. Compliance with screening is lower both in women with HIV and other immune-mediated disease. Improving screening compliance in this high-risk population with a simplified screening strategy is likely the most important factor for reducing the risk of cervical cancer and further research is needed.

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Authors and Affiliations

  1. Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Michelle Davis & Sarah Feldman

  2. Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA, USA

    R. Perkins

  3. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA

    J. Cain

Authors
  1. Michelle Davis
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  2. R. Perkins
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  3. J. Cain
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  4. Sarah Feldman
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Correspondence to Michelle Davis or Sarah Feldman.

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Conflict of Interest

M. Davis, R. Perkins, J. Cain, and S. Feldman declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Gynecologic Oncology

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Davis, M., Perkins, R., Cain, J. et al. Cervical Cancer Screening and the Immunosuppressed Patient: the Issues in Screening High-Risk Populations. Curr Obstet Gynecol Rep 5, 307–317 (2016). https://doi.org/10.1007/s13669-016-0180-0

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  • DOI: https://doi.org/10.1007/s13669-016-0180-0

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