Cleveland Clinic Journal of Medicine

Cervical cancer screening in high-risk patients: Clinical challenges in primary care

The risk of developing cervical cancer is not equal across populations-individual health history, economic, political, and societal factors influence cervical cancer risk. Certain health conditions, including human immunodeficiency virus (HIV) infection, immunosuppression, and history of high-grade cervical dysplasia, are associated with higher cervical cancer risk and warrant distinct screening, surveillance, and management guidelines. It is imperative for clinicians to recognize high-risk groups and apply appropriate corresponding guidelines. However, this can be difficult in practice, as recommendations regularly evolve. This review offers up-to-date guidance in a case-based format on cervical cancer screening, surveillance, and management for high-risk patients.

Risk-based guidelines: Redefining management of abnormal cervical cancer screening results

In making the 2019 guidelines for risk-based management of patients with abnormal cervical cancer screening tests and cancer precursors, the guidelines committee shifted from results-based to risk-based management recommendations, based on the patient's immediate and 5-year risks of grade 3 or higher cervical intraepithelial neoplasia (CIN 3+). The risk is determined by current and prior screening results (human papillomavirus infection, cytology testing) and the clinical history including age. An immediate 4% or higher risk of CIN 3+ was established as the dividing line between higher and lower risks, and the corresponding management recommendations. This article reviews the changes and their evidence base and discusses clinical implications of the revised guidelines.

The HPV vaccine: Understanding and addressing barriers to vaccination

Should women with HPV-related noncervical cancers be considered at high risk for cervical cancer?