Abstract
Abnormal cervical screening tests are diagnosed in millions of women each year in the United States. In some, the abnormality is indicative of cervical dysplasia or even invasive cervical cancer. The work-up of an abnormal cervical screening test includes colposcopy and cervical biopsies. Based on those results, treatment for cervical dysplasia can consist of observation or intervention with an excisional biopsy. In deciding to intervene aggressively, one must consider special circumstances including patient age, desire for future fertility, and concurrent pregnancy. Understanding the role human papillomavirus (HPV) plays in cancer development has led to advancements in detection and treatment of cervical dysplasia. Both preventative and therapeutic vaccinations against HPV provide promise in decreasing the number of women affected by this disease. This chapter highlights key changes in the recent ASCCP guidelines including the importance of conservative management among younger women as well as recommendations on the proper utilization of HPV cotesting. The rationale for HPV vaccination is also discussed.
References
ACOG. Practice Bulletin Number 140: management of abnormal cervical cancer screening test results and cervical cancer precursors. Obstet Gynecol. 2013;122(6):1338–67.
ASCUS-LSIL Triage Study (ALTS) Group. Results of a randomized trial on the management of cytology interpretations of atypical squamous cells of undetermined significance. Am J Obstet Gynecol. 2003;90:366–371.
Adegoke O, Kulasingam S, Virnig B. Cervical cancer trends in the United States: a 35-year population based analysis. J Women’s Health. 2012;21(10):1031–7.
Arbyn M, Bergeron C, et al. Liquid compared with conventional cervical cytology: a systemic review and meta-analysis. Obstet Gynecol. 2008;111(1):167–77.
Baggish MS. Colposcopy of the cervix, vagina and vulva: a comprehensive textbook. Philadelphia: Mosby; 2003. p. 79–97.
Baldur-Felskov B, Dehlendorff C, Munk C, Kjaer SK. Early impact of human papillomavirus vaccination on cervical neoplasia: nationwide follow-up of Young Danish women. JNCI J Natl Cancer Inst. 2014;106(3):djt460.
de Sanjose S, Quint WG, Alemany L, et al. Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study. Lancet Oncol. 2010;11:1048–56.
Erickson BK, Alvarez RD, Huh WK. Human papillomavirus: what every provider should know. Am J Obstet Gynecol. 2013;208(3):169–75.
Fader AN, Alward EK, Niederhauser A, et al. Cervical dysplasia in pregnancy: a multi-institutional evaluation. Am J Obstet Gynecol. 2010;203:113.e1–6.
Frey HA, Conner SN. Treatment of cervical dysplasia and the risk of preterm birth: understanding the association. Am J Obstet Gynecol. 2015;213(4):445–6.
Grimm C, Polterauer S, Natter C, et al. Treatment of cervical intraepithelial neoplasia with topical imiquimod: a randomized controlled trial. Obstet Gynecol. 2012;120:152–9.
Huang LW, Hwang JL. A comparison between loop electrosurgical excision procedure and cold knife conization for treatment of cervical dysplasia: residual disease in a subsequent hysterectomy specimen. Gynecol Oncol. 1999;73(1):12–5.
Huh W, Sideri M, et al. Relevance of random biopsy at the transformation zone when colposcopy is negative. Obstet Gynecol. 2014;124(4):670–8.
Insinga RP, Glass AG, Rush BB. Diagnoses and outcomes in cervical cancer screening: a population-based study. Am J Obstet Gynecol. 2004;191:105–13.
Joura EA, Giuliano AR, Iversen OE, et al. A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women. N Engl J Med. 2015;372:711–23.
Kobak WH, Roman LD, et al. The role of endocervical curettage at cervical conization for high-grade dysplasia. Obstet Gynecol. 1996;85:197–201.
Mahmud SM, Kliewer EV, Lambert P, Bozat-Emre S, Demers AA. Effectiveness of the quadrivalent human papillomavirus vaccine against cervical dysplasia in Manitoba, Canada. J Clin Oncol. 2014;32:438–43.
Morrow CP, Sideri M. Surgery for cervical neoplasia. In: Gynecologic cancer surgery. Encinitas: South Coast Medical Publishing; 2013. p. 513–33.
Nanda K, McCrory DC, et al. Accuracy of the papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: a systemic review. Ann Intern Med. 2000;132:810–9.
Nguyen ML, Flowers L. Cervical cancer screening in immunocompromised women. Obstet Gynecol Clin N Am. 2013;40(2):339–57.
Nooh AM, Mohamed ME, El-Alfy Y. Visual inspection of cervix with acetic acid as a screening modality for cervical cancer. J Low Genit Tract Dis. 2015;19:340–4.
Rahangdale L, Lippmann OK, Garcia K, et al. Topical 5-fluorouracil for treatment of cervical intraepithelial neoplasia 2: a randomized controlled trial. Am J Obstet Gynecol. 2014;210:314.e1–8.
Robboy SJ, Anderson MC, Russel P. Pathology of the female reproductive tract. Philadelphia: Churchill Livingstone; 2002. p. 165–93.
Seer database: http://seer.cancer.gov/statfacts/html/cervix.html
Solomon D, Darvy D, Kurman R, et al. The 2001 Bethesda system: terminology for reporting results of cervical cytology. JAMA. 2002;287:2114–9.
Tierney KE, Lin PS, Amezcua C, et al. Cervical conization of adenocarcinoma in situ: a predicting model of residual disease. Am J Obstet Gynecol. 2014;210:366.e1–5.
Trimble CL, Morrow MP, Kraynyak KA, et al. Safety, efficacy, and immunogenicity of VGX-3100, a therapeutic synthetic DNA vaccine targeting human papillomavirus 16 and 18 E6 and E7 proteins for cervical intraepithelial neoplasia 2/3: a randomized, double-blind, placebo-controlled phase 2b trial. Lancet. 2015;386:2078. Published online.
Wheeler CM. The natural history of cervical human papillomavirus infection and cervical cancer: gaps in knowledge and future horizons. Obstet Gynecol Clin N Am. 2013;40:165–76.
Wright TC Jr, Massad LS, et al. 2006 consensus guidelines for the management of women with abnormal cervical screening tests. J Low Genit Tract Dis. 2007;11(4):201–22.
Wright TC. Pathogenesis and diagnosis of preinvasive lesions of the lower genital tract. In: Principles and practice of gynecologic oncology. Philadelphia: Lippincott/Williams and Wilkins; 2009.
Wright TC, Stoler MH, et al. The ATHENA human papillomavirus study: design, methods, and baseline results. Am J Obstet Gynecol. 2012;206:46.e8–11.
Zhao C, et al. Human papillomavirus testing and reporting rates in 2012: results of a College of American Pathologists National Survey. Arch Pathol Lab Med. 2015;139:756–61.
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Tierney, K.E., Roman, L.D., Matsuo, K. (2016). Management of Cervical Dysplasia. In: Shoupe, D. (eds) Handbook of Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-319-17002-2_7-1
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DOI: https://doi.org/10.1007/978-3-319-17002-2_7-1
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