Editing Cervical cancer (section)

=== Screening ===
[[File:Cervical screening Test Vehicle in Minsheng Community 20120421.jpg|thumb|Cervical screening test vehicle in [[Taiwan]]]]
[[File:VIANeg.gif|thumb|Negative visual inspection with acetic acid of the cervix]]
[[File:VIAPosCIN1.gif|thumb|Positive visual inspection with acetic acid of the cervix for [[CIN-1]]]]
{{Main|Cervical screening|Pap test}}
Checking cervical cells with the [[Pap test|Papanicolaou test]] (Pap test) for cervical pre-cancer has dramatically reduced the number of cases of, and mortality from, cervical cancer.<ref name=pmid10735343/> Liquid-based cytology may reduce the number of inadequate samples.<ref>{{cite journal |vauthors=Payne N, Chilcott J, McGoogan E |title=Liquid-based cytology in cervical screening: a rapid and systematic review |journal=Health Technology Assessment |volume=4 |issue=18 |pages=1–73 |year=2000 |pmid=10932023 |doi=10.3310/hta4180 |doi-access=free}}</ref><ref>{{cite journal |vauthors=Karnon J, Peters J, Platt J, Chilcott J, McGoogan E, Brewer N |title=Liquid-based cytology in cervical screening: an updated rapid and systematic review and economic analysis |journal=Health Technology Assessment |volume=8 |issue=20 |pages=iii, 1-iii, 78 |date=May 2004 |pmid=15147611 |doi=10.3310/hta8200 |doi-access=free}}</ref><ref>{{cite web |url=http://www.cancerscreening.nhs.uk/cervical/lbc.html |title=Liquid Based Cytology (LBC): NHS Cervical Screening Programme|archive-url=https://web.archive.org/web/20110108144400/http://www.cancerscreening.nhs.uk/cervical/lbc.html |archive-date=8 January 2011 |url-status=live |access-date=1 October 2010}}</ref> Pap test screening every three to five years with appropriate follow-up can reduce cervical cancer incidence up to 80%.<ref name=Arbyn10>{{cite journal | vauthors = Arbyn M, Anttila A, Jordan J, Ronco G, Schenck U, Segnan N, Wiener H, Herbert A, von Karsa L | display-authors = 6 | title = European Guidelines for Quality Assurance in Cervical Cancer Screening. Second edition--summary document | journal = Annals of Oncology | volume = 21 | issue = 3 | pages = 448–458 | date = March 2010 | pmid = 20176693 | pmc = 2826099 | doi = 10.1093/annonc/mdp471 }}</ref>

Pap test screening can reveal abnormal cells on the surface of the cervix called [[cervical intraepithelial neoplasia]] (CIN) which in a small percentage can develop into cervical cancer. These [[cervical intraepithelial neoplasia|precancerous changes]] can be confirmed with further examination known as [[colposcopy]].

Personal invitations encouraging women to get screened are effective at increasing the likelihood they will do so. Educational materials also help increase the likelihood that women will go for screening, but they are not as effective as invitations.<ref>{{cite journal | vauthors = Staley H, Shiraz A, Shreeve N, Bryant A, Martin-Hirsch PP, Gajjar K | title = Interventions targeted at women to encourage the uptake of cervical screening | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | issue = 9 | pages = CD002834 | date = September 2021 | pmid = 34694000 | pmc = 8543674 | doi = 10.1002/14651858.CD002834.pub3 }}</ref>

According to the 2010 European guidelines, the age at which to start screening ranges between 20 and 30 years of age, but preferentially not before age 25 or 30 years, and depends on the burden of the disease in the population and the available resources.<ref name="Arbyn10"/>

In the United States, screening is recommended to begin at age 21, regardless of the age at which a woman began having sex or other risk factors.<ref name=USAScreen2014/> Pap tests should be done every three years between the ages of 21 and 65.<ref name=USAScreen2014/> In women over the age of 65, screening may be discontinued if no abnormal screening results were seen within the previous 10 years and no history of CIN2 or higher exists.<ref name=USAScreen2014>{{cite web|title=Cervical Cancer Screening Guidelines for Average-Risk Women|website=cdc.gov |url=https://www.cdc.gov/cancer/cervical/pdf/guidelines.pdf |access-date=8 November 2014|url-status=live|archive-url=https://web.archive.org/web/20150201182536/http://www.cdc.gov/cancer/cervical/pdf/guidelines.pdf|archive-date=1 February 2015}}</ref><ref name=Committee38/><ref name=Kar2013>{{cite journal |vauthors=Karjane N, Chelmow D |title=New cervical cancer screening guidelines, again |journal=Obstetrics and Gynecology Clinics of North America |volume=40 |issue=2 |pages=211–223 |date=June 2013 |pmid=23732026 |doi=10.1016/j.ogc.2013.03.001}}</ref> HPV vaccination status does not change screening rates.<ref name=Committee38>{{cite journal |title=ACOG Practice Bulletin Number 131: Screening for cervical cancer |journal=Obstetrics and Gynecology |volume=120 |issue=5 |pages=1222–1238 |date=November 2012 |pmid=23090560 |doi=10.1097/AOG.0b013e318277c92a |author1=Committee on Practice Bulletins—Gynecology}}</ref>

A number of recommended options exist for screening those 30 to 65.<ref name=USPSTF2018/> This includes cervical cytology every 3 years, HPV testing every 5 years, or HPV testing together with cytology every 5 years.<ref name=USPSTF2018>{{cite journal | vauthors = Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW, Kemper AR, Kubik M, Landefeld CS, Mangione CM, Phipps MG, Silverstein M, Simon MA, Tseng CW, Wong JB | display-authors = 6 | title = Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement | journal = JAMA | volume = 320 | issue = 7 | pages = 674–686 | date = August 2018 | pmid = 30140884 | doi = 10.1001/jama.2018.10897 | doi-access = free }}</ref><ref name=Committee38/> Screening is not beneficial before age 25, as the rate of disease is low. Screening is not beneficial in women older than 60 years if they have a history of negative results.<ref name=NIHNCIHPV2015/> The American Society of Clinical Oncology guideline has recommend for different levels of resource availability.<ref name="Primary Prevention of Cervical Canc">{{cite journal | vauthors = Arrossi S, Temin S, Garland S, Eckert LO, Bhatla N, Castellsagué X, Alkaff SE, Felder T, Hammouda D, Konno R, Lopes G, Mugisha E, Murillo R, Scarinci IC, Stanley M, Tsu V, Wheeler CM, Adewole IF, de Sanjosé S | display-authors = 6 | title = Primary Prevention of Cervical Cancer: American Society of Clinical Oncology Resource-Stratified Guideline | journal = Journal of Global Oncology | volume = 3 | issue = 5 | pages = 611–634 | date = October 2017 | pmid = 29094100 | pmc = 5646902 | doi = 10.1200/JGO.2016.008151 }}</ref>

Pap tests have not been as effective in developing countries.<ref name=":0">{{Cite book|title = Comprehensive cervical cancer control. A guide to essential practice | edition = Second | publisher = World Health Organization|year = 2014|isbn = 978-92-4-154895-3|url =https://www.who.int/reproductivehealth/publications/cancers/cervical-cancer-guide/en/|url-status = live|archive-url = https://web.archive.org/web/20150504101022/http://www.who.int/reproductivehealth/publications/cancers/cervical-cancer-guide/en/|archive-date = 4 May 2015}}</ref> This is in part because many of these countries have an impoverished health care infrastructure, too few trained and skilled professionals to obtain and interpret Pap tests, uninformed women who get lost to follow-up, and a lengthy turn-around time to get results.<ref name=":0" /> Visual inspection with acetic acid and HPV DNA testing has been tried, though with mixed success.<ref name=":0" />