tailieunhanh - Colposcopy, Cervical Screening, and HPV

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. The work of the cytotechnologist is often assisted and in some cases, replaced by electronic. | Colposcopy Cervical Screening and HPV Contents Foreword xiii William F. Rayburn Preface xv Alan G. Waxman Natural History of Human Papillomavirus Infections Cytologic and Histologic Abnormalities and Cancer 519 Cosette Marie Wheeler Over 100 human papillomavirus HPV types have been identified to date of which over 40 infect the genital tract primarily through sexual transmission. The many different genital HPV types appear to infect resolve or persist and cause abnormal cytology and cervical intraepithelial neoplasia. Several cofactors have been associated with HPV persistence and lesion progression including smoking long-term oral contraceptive use other sexually transmitted infections host immunogenetics and viral factors such as HPV type and HPV variants. Given the discovery of HPV as the single primary cause of invasive cervical cancer primary and secondary interventions have been realized including HPV testing in cervical screening programs and prophylactic HPV vaccines. Because first generation HPV vaccines only target the two most common HPV types found in cervical cancer HPV 16 and 18 cervical screening programs must continue and the relative roles of HPV vaccination in young women and HPV testing in older women alone or in conjunction with cytology will be determined over the next decades. Cervical Cancer Screening in the Early Postvaccine Era 537 Alan G. Waxman The Pap test is the foundation of cervical cancer screening in North America and most industrialized countries. It has been widely used in the United States since the 1950s. But are our current screening guidelines still justified In this article the author reviews the current recommendations for cervical cancer screening by the American Cancer Society ACS and the American College of Obstetricians and Gynecologists ACOG and the evidence supporting them reviews the relative efficacy of liquid-based cytology versus the conventional Pap smear and discusses the role of HPV DNA testing in primary .