Correlation Between Cervical Disease Symptoms And Signs With Cytology And Colposcopy Biopsy

Abstract

Cervical cancer deaths continue to burden the population, especially the low-income group of countries. The Global cancer observatory, in year 2020, estimated that there were,604,127 new cases and 341,832 deaths worldwide due to cervical cancer. In India, it accounted for 9.4% of all cancers and 18.3% of new cases of cervical cancer in 2020(1) Breast, oral cavity and cervix uteri are the first, second and third most common sites of cancers among both sexes and all ages according to NHFS-5 5(2)

Efforts are being made since decades to detect the disease in preinvasive stage and manage them accordingly to achieve preventable morbidity and mortality due to late diagnosis of the disease. In 2020, THE WORLD HEALTH ASSEMBLY, endorsed the WHO Global strategy for elimination of cervical cancer. It defines elimination as reducing the number of new cases annually to 4 or fewer per 100000 women and in line with that goal, it set 3 targets to achieved by 2030. They are a) to vaccinated 90% of girls by age 15 with HPV vaccine b) to screen 70% of eligible women with high quality test at least twice in her lifetime (age 35 and 45) c) to effectively treat 90% of those with positive screening test or cervical lesion, including palliative care when needed. The WHO believes by the above strategy prevents a cumulative 74 million new cases and avoids death by nearly 62 million by the year 2120(3)

In India, the nation cancer control program (NCCP) was launched in 1975. Series of policies to strengthen the program were done, with evaluation of the effectiveness of the strategies and necessary revision were done in the following years. NCCP was finally merged with the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular disease and Stroke (NPCDCS) in the year 2010 (4)

The guideline that are highly accepted for screening of cervical cancer is that advised by US Preventive Services Task Force (2018) and American Cancer Society (2020) (5,6)

Papanicolaou test (cytology) still continues to be primary screening method as per USPSTF guidelines and will remain as such in many countries till highly sensitive HPV DNA test is easily accessible and affordable. There is wide range in sensitivity and specificity to detect cervical pathology. This is because of the challenges the lie in sustaining the quality of the test at all stages before the report. The sensitivity 32.1% to 87.55% and specificity 89.2% to 99.5% . (7)

The WHO has recommended 7 algorithms, of which algorithm 3 uses Cytology as Primary screening followed by Colposcopy for those above ASCUS-U.   Colposcopic examination and histopathology remain the gold standard for accurate diagnosis of cervical lesions. WHO recommends algorithm 3, 6 & 7 colposcopy directly after primary testing or after cytology triage. (3)