gynecology and obstetrics medical project, gynecology journal, obstetrics, gynecologic oncology, reproductive medicine, gynecological endoscopy, ultrasonography, gynecology articles

Ginekologia i Poloznictwo
ISSN 1896-3315 e-ISSN 1898-0759

The development of screening, diagnosis and management with abnormal Pap test results


Author(s): Wojciech Homola (ABCDEF), Tomasz Fuchs (ABDEF), Michał Pomorski (ADEF), Anna Rosner-Tenerowicz (BDEF), Mariusz Zimmer (ADEF)

Cervical cancer is a significant oncological problem from the point of view of primary and secondary prevention as well as extended diagnosis of abnormal Pap test results. This disease is the fourth most common cancer and the fourth cause of death from cancer among women, with the worldwide prevalence of 600,000 and death rate of 300,000 in 2018. In Poland, there were 2,622 new cases of cervical cancer and 1,550 deaths from this disease in 2018. Cervical cancer incidence and mortality rates are gradually declining, particularly in highly developed countries, owing to elimination of risk factors, improvement of socioeconomic and hygienic conditions, and introduction of screening programs. Cervical cancer prevention involves primary (avoidance of HPV infection, HPV vaccination) and secondary techniques (Pap smears and other modern ways of detecting precancerous conditions). The aim of screening in healthy women is early detection of the disease, enabling early initiation of effective treatment. At present, the Pap test is commonly used in cervical cancer prevention. However, due to its low sensitivity and specificity, new methods of extended diagnosis are being developed in order to detect precancerous conditions of the cervix accurately, rapidly and in a relatively non-expensive way. Apart from the Pap test, other promising techniques of screening and extended diagnosis are: folate receptor-mediated staining, transition zone scanning with ZedScan, automated visual evaluation of the cervix with 3–5% acetic acid staining, and the use of silver nanoparticles in the management of chronic inflammation of the cervix and abnormal Pap smear results. The new methods, tested in clinical practice at the 2nd Department of Obstetrics and Gynecology of Wroclaw Medical University in Poland, markedly improve the sensitivity and specificity of CIN2+ detection. This paper presents new techniques of screening and extended diagnosis on the background of results offered by Pap smears and own experience. The plethora of currently tested methods of extended screening for cervical cancer is promising and gives hopes that the Pap test will soon be supplemented with more accurate examinations. The presented methods share common advantages: they are non-invasive, simple to implement and yield real-time results. Works on new techniques may contribute to the development of screening methods and make effective screening for cervical cancer more widespread in Poland, where the prevalence of this disease is still high compared with other European countries.