Vaginal cancer screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:  Syed Musadiq Ali M.B.B.S.[2]

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## Overview[edit | edit source]

* There is no general screening programme for vaginal cancer because it’s a very rare condition.
* When you have a cervical screening test, the doctor or nurse does a routine examination of your vagina at the same time. They can pick up pre cancerous conditions such as vaginal intraepithelial neoplasia (VAIN). Treatment for VAIN prevents vaginal cancer from developing.
* Screening is done by means of vaginal Pap smears in women who had previously undergone a hysterectomy for benign gynecologic disease.[1]
* In the United States, annual vaginal Pap smears have been recommended for the possible detection of vaginal cancer even for women who have previously undergone a hysterectomy, despite the fact that evidence of the value of such screening in this group of patients is virtually nonexistent[2].
* In 1995, the American College of Obstetricians and Gynecologists recommended that such women be screened periodically, yet it acknowledged that no data were available to support the recommendation.[3]
* The relationship between the human papillomavirus (HPV) and malignancies of the uterine, cervix, vagina, and vulva has been established.
* The prevalence of oncogenic HPV subtypes in cervical cancers has been the most studied, but prevalence has also been established for vaginal and vulvar cancers. Clinical trials demonstrate impressive efficacy in disease prevention as well as excellent safety and tolerability. Screening cervical cancer can reduce the risk of vaginal cancer[4].

## Screening Guidelines[edit | edit source]

| American Cancer Society (ACS), American Society for Colposcopy and Cervical Pathology (ASCCP), and American Society for Clinical Pathology  | U.S. Preventive Services Task Force (USPSTF) | American College of Obstetricians and Gynecologists (ACOG)

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When to start screening  | Age 21. Women aged <21 years should not be screened regardless of the age of sexual initiation or other risk factors  | Age 21. (A recommendation) Recommend against screening women aged <21 years (D recommendation)  | Age 21 regardless of the age of onset of sexual activity. Women aged <21 years should not be screened regardless of age at sexual initiation and other behavior-related risk factors (Level A evidence)
Statement about annual screening  | Women of any age should not be screened annually by any screening method  | Individuals and clinicians can use the annual Pap test screening visit as an opportunity to discuss other health problems and preventive measures. Individuals, clinicians, and health systems should seek effective ways to facilitate the receipt of recommended preventive services at intervals that are beneficial to the patient. Efforts also should be made to ensure that individuals are able to seek care for additional health concerns as they present  | In women aged 30–65 years, annual cervical cancer screening should not be performed. (Level A evidence) Patients should be counseled that annual well-woman visits are recommended even if cervical cancer screening is not performed at each visit
Screening method and intervals  |
Cytology (conventional or liquid based)  | 21–29 years  | Every 3 years  | Every 3 years (A recommendation)  | Every 3 years (Level A evidence)
30–65 years  | Every 3 years  | Every 3 years (A recommendation)  | Every 3 years (Level A evidence)
HPV co-test (cytology + HPV test administered together)  | 21–29 years  | HPV co-testing should not be used for women aged <30 years  | Recommend against HPV co-testing in women aged <30 years (D recommendation)  | HPV co-testing should not be performed in women aged <30 years. (Level A evidence )
30–65 years  | Every 5 years; this is the preferred method.  | For women who want to extend their screening interval, HPV co-testing every 5 years is an option (A recommendation)  | Every 5 years; this is the preferred method (Level A evidence)
Primary hrHPV f testing (as an alternative to cotesting or g cytology alone)  | For women aged 30–65 years, screening by HPV testing alone is not recommended in most clinical settings  | Recommend against screening for cervical cancer with HPV testing (alone or in combination with cytology) in women aged <30 years (D recommendation)  | Not addressed
When to stop screening  | Aged >65 years with adequate negative prior screening* and no history of CIN2 or higher within the last 20 years  | Aged >65 years with adequate screening history* and are not otherwise at high risk for cervical cancer (D recommendation)  | Aged >65 years with adequate negative prior screening* results and no history of CIN 2 or higher (Level A evidence)
When to screen after age 65 years  | When to screen after age 65 years Aged >65 years with a history of CIN2 CIN2, CIN3, or adenocarcinoma in situ, routine screeningk should continue for at least 20 years  | Women aged >65 years who have never been screened, do not meet the criteria for adequate prior screening, or for whom the adequacy of prior screening cannot be accurately accessed or documented.l Routine screeningk should continue for at least 20 years after spontaneous regression or appropriate management of a high-grade precancerous lesion, even if this extends screening past age 65 years. Certain considerations may support screening in women aged > 65 years who are otherwise considered high risk (such as women with a highgrade precancerous lesion or cervical cancer, women with in utero exposure to diethylstilbestrol, or women who are immunocompromised)  | Women aged >65 years with a history of CIN2, CIN3, or AIS should continue routine agebased screeningk for at least 20 years (Level B evidence)
Screening post-hysterectomy  | Women who have had a total hysterectomy (removal of the uterus and cervix) should stop screening.Women who have had a supra-cervical hysterectomy (cervix intact) should continue screening according to guidelines  | Recommend against screening in women who have had a hysterectomy (removal of the cervix) (D recommendation)  | Women who have had a hysterectomy (removal of the cervix) should stop screening and not restart for any reason, (Level A evidence)
The need for a bimanual pelvic exam  | Not addressed in 2012 guidelines but was addressed in 2002 ACS guidelines  | Addressed in USPSTF ovarian cancer screening recommendations (draft)  | Addressed in 2012 well-woman visit recommendations.Aged <21 years, no evidence supports the routine internal examination of the healthy, asymptomatic patient. An “external-only” genital examination is acceptable. Aged ≥21 years, no evidence supports or refutes the annual pelvic examination or speculum and bimanual examination. The decision whether or not to perform a complete pelvic examination should be a shared decision after a discussion between the patient and her health care provider. Annual examination of the external genitalia should continue
Screening among those immunized against HPV 16/18  | Women at any age with a history of HPV vaccination should be screened according to the age specific recommendations for the general population  | The possibility that vaccination might reduce the need for screening with cytology alone or in combination with HPV testing is not established. Given these uncertainties, women who have been vaccinated should continue to be screened  | Women who have received the HPV vaccine should be screened according to the same guidelines as women who have not been vaccinated (Level C evidence)

HPV = human papillomavirus; CIN = cervical intraepithelial neoplasia; AIS=adenocarcinoma in situ; hrHPV = high-risk HPV.

## References[edit | edit source]

1. ↑ Noller KL (November 1996). "Screening for vaginal cancer". N. Engl. J. Med. 335 (21): 1599–600. doi:10.1056/NEJM199611213352111. PMID 8900096.
2. ↑ "ACOG committee opinion. Recommendations on frequency of Pap test screening. Number 152--March 1995. Committee on Gynecologic Practice. American College of Obstetricians and Gynecologists". Int J Gynaecol Obstet. 49 (2): 210–1. May 1995. PMID 7649335.
3. ↑ Wright TC, Sun XW, Koulos J (February 1995). "Comparison of management algorithms for the evaluation of women with low-grade cytologic abnormalities". Obstet Gynecol. 85 (2): 202–10. doi:10.1016/0029-7844(94)00373-L. PMID 7824231.
4. ↑ Diaz ML (August 2010). "Prevention of cervical, vaginal, and vulval cancers: role of the quadrivalent human papillomavirus (6, 11, 16, 18) recombinant vaccine". Int J Womens Health. 1: 119–29. PMC 2971720. PMID 21072282.