Cervical cytology

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  • Those of us involved in the healthcare of women have seen a remarkable transformation in screening techniques for cervical cancer and its precursors since the mid 1990s.  The staid old Pap smear technique of scraping cells from the cervix with a wooden spatula and cotton-tipped applicator and smearing them onto a glass slide is a thing of the past in most practices. We now use plastic collection devices to transfer cells from the cervix into a preservative which is sent to the lab for liquidbased cytology and reflex human papillomavirus (HPV) testing.

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  • Screening for precancerous lesions can be done in several ways including, cervical cytology (Pap tests), visual inspection of the cervix with acetic acid [VIA] or testing for HPV DNA. Each of these methods has specific advantages, disadvantages and health systems requirements that countries should consider when planning screening programmes (See Annex 1).

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  • Screening for cervical cancer with cervical cytology reduced the incidence of cervical cancer by more than 50% over the past 30 years in the United States [8]. However, it is estimated that 50% of the women in whom cervical cancer is diagnosed each year will have never had cervical cytology testing [8]. One approach for further reducing the incidence and the mortality of cervical cancer would be to increase the screening rates among groups of women at highest risk, who currently are not being screened.

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  • Cytological screening every three to five years can prevent up to four out of five cases of cervical cancer. Such benefits can only be achieved if screening is provided in organized, population-based programmes with quality assurance at all levels. This is an important lesson which has been learned through pan-European cooperation and collaboration in the European Cancer Network.

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  • Exfoliative cytologic examination of specimens from the lower genital tract (Pap smear) is a screening tool that has been so valuable in the detection of premalignant and malignant lesions that it has been almost universally adopted as the primary cancer screening method for cervical cancer, an integral part of the health care of women. This has resulted in a 50% reduction of invasive cancers of the cervix alone. Although cervical cytology may detect endometrial cancer (in 15%–50%), it does not carry the same reliability as a screening tool for endometrial neoplasia. ...

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  • A cervical cytological sample is considered satisfactory for cytological diagnosis when their composition reflects the mucosal lining of the cervix, encompassing ectocervical, squamous metaplastic cells and endocervical columnar cells in fair numbers. It is generally agreed that majority of epithelial abnormalities that eventually lead to an invasive cancer originate in the squamo-columnar junction (transformation zone). As stated by the British Society for Clinical Cytology (BSCC), a cervical smear if properly taken should contain cells from the whole transformation zone(TZ).

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  • Endometrial, cervical, and ovarian cancers are the three most common malignancies of the female reproductive tract. In the United States alone, roughly 12,000 women are diagnosed with uterine cervical cancer annually, and 4,000 will die from the disease [1]. The relatively low incidence of cervical cancer in the US is largely attributable to the effectiveness of Papanicolaou’s cytological cervical screening test (the Pap test).

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  • The speculum should be carefully positioned so the entire cervix is seen. If excess mucus or other secretions obscure the cervix, they should be gently removed using a proctoswab without disturbing the epithelium. Small amounts of blood will not interfere with cytologic evaluation, but large amounts, as occurs during menses, preclude cytologic interpretation by conventional Pap smear. This is considerably less of a problem when liquid based cytology is used.

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  • When starting a cervical cancer prevention and control programme, cytology-based screening is not advisable, as sensitivity of this methodology is low and health systems requirements to ensure good quality and adequate coverage are high. If appropriate, a combination of different screening modalities followed by treatment may be used depending on the geographical area, infrastructure and human resource capacity in the country.

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