SCREENING OF REPRODUCTIVE TRACT CANCERS

CANCER CERVIX

Cervical cancer screening detects precancerous lesions and early-stage disease, the treatment of which decreases the incidence of cervical cancer and cervical cancer mortality, respectively.

Women <30 years

  • Pap test alone at intervals of every three years.

not to be screened with HPV testing (primary or co-testing

Women ≥30 years

  • Pap test every three years
  • Co-testing (Pap test and HPV testing) every five years if both initial tests are negative
  • Frequency of testing — When co-testing is used as the screening method, we suggest screening every five years if both tests are negative. A screening interval of five years provides a balance of benefits and risks that is comparable to cytology screening every three years .

UTERINE CANCER

  • Postmenopausal women – Any uterine bleeding, regardless of volume (including spotting or staining). sonographic finding of an endometrial thickness >4 mm (even if the patient has no uterine bleeding).
  • Age 45 years to menopause – Any abnormal uterine bleeding, including intermenstrual bleeding in women who are ovulatory. Abnormal uterine bleeding in any woman that is frequent (interval between the onset of bleeding episodes is less than 21 days), heavy (total volume of >80 mL), or prolonged (longer than seven days).

Younger than 45 years – Abnormal uterine bleeding that is persistent, occurs in the setting of a                                   history of unopposed estrogen exposure (obesity, chronic anovulation) or failed medical management of      the bleeding, or in women at high risk of endometrial cancer (eg, tamoxifen therapy, Lynch syndrome, Cowden syndrome

Postmenopausal women :

  • ET less than or equal to 4 or 5 mm is associated with a low risk of endometrial disease
  • Cancer becomes increasingly more frequent relative to benign disease as the endometrial thickness approaches 20 mm

Endometrial biopsy is  preferred initial test for women with abnormal uterine bleeding due to its high sensitivity, low complication rate, and low cost.

CARCINOMA OVARY

  • Tests that may be useful for screening in certain circumstances include measurement of the CA 125 tumor marker or other serologic markers, ultrasonography, and combinations of these modalities.
  • Ovarian cancer symptom index — The index is considered to be positive in women who report pelvic or abdominal pain, bloating, increased abdominal size, difficulty eating or early satiety occurring more than 12 times a month, with symptoms present for less than one year(To be combined with pelvic examination, TVUS & CA-125.) Early reporting of these symptoms to the gynae cancer specialist.
  • Family history of Breast/Ovary/Intestinal cancers

NO sufficient evidence to support screening for ovarian cancer in any population, including women at increased risk