Persisting Dilemmas in Etiology and Challenges in Screening and Diagnosis of Cervical Pre-cancer and Cancer

Abstract

Introduction: Cervical cancer is probably fifth amongst all cancers, third most common in women after breast, colorectal in some countries. Recent trends reveal resurgence in developed countries too. Dilemmas continue about which cervical dysplasia/ cervical intraepithelial neoplasms are precursors of cancer and after how much interval. Objectives: The objective is to look at dilemmas in ethology of cervical cancer, challenges in screening and diagnosis of pre-cancer, cancer. Methodology: Simple review of literature was done by various search engines and personal experience was added. Results: Geographic variations in cervical cancer rates reflect differences in presence or absence of etiological factors and screening of pre-cancer. Molecular studies revealed human papilloma viruses (HPV)16, 18 as most oncogenic, long-term hormonal contraceptives, high parity, early sexual activity, multiple sex partners, tobacco smoking, co-infection with HIV as identified cofactors, and co-infection with Chlamydia trachomatis, Herpes simplex virus type-2, immunosuppression, low economic status, poor hygiene, low dietary antioxidants probable cofactors. Genetic, immunological factors play some role. However, role of none seems to be clear. Dilemmas continued about many factors. Discussion: Cervical cytology most commonly used conventional screening has many limitations, danger of cells drying, poor quality, reporting problems. So, liquid based, thin layer cytology is advocated which has limitations. False negative/positive results continue. Histopathology is essential but necrosis in advanced cases creates problems. Visual inspection, visual inspection using acetic acid, lugol’s iodine has varying results. Point-of-care, affordable HPV tests are elusive. Standard cytology-based programs in high-resource countries have been colposcopic localization and biopsy in screen-positive. However false positivity and overtreatment continue. Many challenges limit utilily of screening with colposcopy. Research continues to search for useful biochemical, microbiological markers. Conclusion: Dilemmas in ethology of cervical cancer and challenges in screening, diagnosis still continue. Risk of overtreatment outweigh risk of high-grade lesions, invasive cancers untreated. Research needs to continue.