Cervical Cancer Screening
Rationale and Background
HIV disease is associated with an increased risk of cervical dysplasia and cancer in women. Most patients who develop these conditions have a prior history of human papillomavirus (HPV) infection, which is a sexually transmitted pathogen that causes genital warts. The risk of developing cervical disease is greatest in women with advanced HIV disease.Pap smear has been demonstrated to be a useful screening test for cervical dysplasia. Its routine use in populations at risk decreases morbidity and mortality from cervical neoplasia.
Guidelines
A pelvic examination and Pap smear should be performed as part of the initial evaluation of all HIV-infected women, repeated six months later, and, if normal, repeated at twelve month intervals thereafter. Colposcopy is not recommended as a screening test in this population.More frequent Pap smear evaluations (every four to six months) are recommended in the following circumstances:
- if endocervical component is absent
- if there is a history of HPV infection
- after treatment for any cervical lesion
Women with abnormal Pap smear results showing cellular atypia or any degree of cervical dysplasia should be referred to a gynecologist for further diagnostic evaluation. In general, colposcopy and biopsy are performed.
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Comments about these guidelines are welcome and can be sent to the author at hlibman@caregroup.harvard.edu