User:Dashdon/Cervical screening

Cervical screening is the process of detecting and removing abnormal tissue or cells in the cervix before cervical cancer develops. By aiming to detect and treat cervical neoplasia early on, cervical screening aims at secondary prevention of cervical cancer. There are wide disparities in cervical screening rates and outcomes, with about 90% of deaths from cervical cancer in 2018 occurring in low and middle-income countries. To help coordinate resources to address this gap, the World Health Organization in 2020 adopted the Global Strategy for Cervical Cancer Elimination. This created the goal of vaccinating 90% of people with cervices against HPV by age 15, screening 70% of people with cervices by age 35 and again by age 45, and treating and managing 90% of patients with pre-cancer and invasive cancer, respectively. Several screening methods for cervical cancer are the Pap test (also known as Pap smear or conventional cytology), liquid-based cytology, the HPV DNA testing and the visual inspection with acetic acid. Pap test and liquid-based cytology have been effective in diminishing incidence and mortality rates of cervical cancer in developed countries but not in developing countries. Prospective screening methods that can be used in low-resource areas in developing countries are the HPV DNA testing and the visual inspection.

Recommendations
Different countries have different cervical screening recommendations.


 * In Europe, most countries suggest or offer screening between the ages of 25 to 64. According to the 2015 European guidelines for cervical cancer screening, routine HPV primary screening should not begin under 30 years of age. Primary testing for oncogenic HPV can be used in a population-based programme for cervical cancer screening. In England, the NHS cervical screening programme is available to women aged 25 to 64; women aged 25 to 49 receive an invitation every 3 years and women aged 50 to 64 receive an invitation every 5 years.
 * In the United States, screening is recommended for women between ages 21–65, regardless of age at sexual initiation or other high-risk behaviors. For healthy women aged 21–29 who have never had an abnormal Pap smear, cervical cancer screening with cervical cytology (Pap smear) should occur every 3 years, regardless of HPV vaccination status. The preferred screening for women aged 30–65 is "co-testing", which includes a combination of cervical cytology screening and HPV testing, every 5 years. However, it is acceptable to screen this age group with a Pap smear alone every 3 years. In women over the age of 65, screening for cervical cancer may be discontinued in the absence of abnormal screening results within the prior 10 years and no history of high-grade lesions. Management of screening results is based on recommendations by the American College of Obstetricians and Gynecologists and other professional organizations.
 * In Australia, screening is offered to women aged 18–70, every two years. This is by Pap smear, and regardless of sexual history.  In Canada, where screening programmes are arranged at provincial level, the general recommendation is not to begin routine screening until the age of 25 in the absence of specific reasons to, then to screen every three years until the age of 69. In Ontario, "The Ontario Cervical Screening Program recommends that women who are or have been sexually active have a Pap test every 3 years starting at age 21."
 * In low-resource countries, decisions regarding cervical screening are made based upon available resources and thus it is often not possible to offer cervical screening as frequently. The greatest impact on cervical cancer reduction appears to result from screening women aged 30 to 39 years, so resources may be directed to that age group.

Co-testing
A newer approach to screening is known as co-testing, in which individuals can receive both high risk HPV testing and cytology. These results can be utilized to calculate the patient's immediate risk for cervical intraepithelial neoplasia grade 3 or cancer (CIN3+). In the United States, several physician organizations such as the American College of Obstetricians and Gynecologists created management guidelines based on the immediate CIN3+ risk over 5 years, instead of the test results themselves. This risk guides clinical decisions, with a risk ≥ 4% leading to more frequent screening, colposcopy, and treatment. Risk ≤ 4% leads to a recommendation of shorter screening intervals. If the risk is low enough, the patient can return to a routine screening interval. Management guidelines are summarized below:

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