Detection, management, and follow‐up of pre‐malignant cervical lesions and the role for human papillomavirus

Abstract

Cervical cytological pathology is common. Prevention of cervical cancer by detecting the disease process at an early and pre-malignant stage is practised globally either through population-based screening programmes (PSP) or through non-organised ones. High-grade cervical intraepithelial neoplasia (CIN) detected by cervical cytological screening is extensively visualised by colposcopy and successively treated by, for instance, large loop electro-surgical excision of the transformation zone. Persistent infections with certain high-risk human papillomavirus (hr-HPV) genotypes play an essential role in cervical cancer carcinogenesis by mechanisms discussed in this review. HPV assessment, either DNA detection or HPV genotyping, could enhance the current cervical cancer screening programmes. Furthermore, primary prevention of cervical cancer through the introduction of HPV vaccines looks promising although the current vaccines merely protect against two hr-HPV genotypes, leaving a niche for at least 11 other hr-HPV's. Cervical screening in the post-vaccination era cannot be abolished but could be altered, as discussed in this review. Algorithms with the primary objective of hr-HPV testing followed by subjective cytology assessment in HPV-positive women could be a solution for both pre- and post-vaccination screening.

CMV vaccine trial endpoints

“…However, their results are less impressive when the total of cervical pre-malignancy is considered, because several other human papillomaviruses can cause such changes. 15 Although there is evidence for cross-protection against genotypes other than HPV16 and 18, there is also evidence that the current vaccines will not protect against disease caused by all strains. 16 By analogy then, the focus of the CMV vaccine study should be stated explicitly to be congenital CMV infection caused by primary maternal infection.…”

Phylogenetic Analysis and Prevalence of Human Papillomavirus (HPV) in Women with Several Cervical Pathologies

“…Over 500,000 new cases diagnosed each year and 275,000 patients die. 80% of the cases observed in developing countries (7) . According to the data of Ministry of Health of the Republic of Turkey; cervical cancer was detected 623 patients in 1996 and seventh among all women's cancers.…”

Ações das equipes de saúde da família na prevenção e controle do câncer de colo de útero

“…Na fase pré-clínica do câncer de colo de útero não se evidenciam sintomas, de forma que a detecção de possíveis lesões precursoras se faz pela realização periódica do exame citológico. Por outro lado, conforme a doença progride, surgem sintomas como sangramento, menorragias e metrorragias (4) . Os meios de prevenção do câncer de colo de útero consistem nos cuidados e informações sobre o uso de preservativos, prevenção de doenças sexualmente transmissíveis (DSTs) e orientações sexuais que estimulem o sexo seguro.…”