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Answer 2nd mbbs pathology ROBBINS AND COTRANS PATHOGENESIS OF DISEASE 2ND YEAR

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WHO cervical cancer screening recommendations HPV Pap test 2021 guideline

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cervical cancer screening

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https://www.who.int/news/item/06-07-2021-new-recommendations…

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1. Cytological features of abnormal cells in a Pap smear (2 marks)

Pathologists look for features of cellular atypia/dysplasia, particularly:
  • Increased nuclear-to-cytoplasmic ratio due to enlarged nuclei and scant cytoplasm.
  • Nuclear hyperchromasia with coarse, irregularly clumped chromatin.
  • Irregular nuclear membrane/contours and nuclear pleomorphism.
  • Loss of normal maturation and polarity of squamous cells.
  • Cells may occur singly or in crowded sheets; severe lesions can show abnormal mitotic activity.
In HSIL, cells are usually small immature basal/parabasal-type cells with scant cytoplasm and markedly atypical, hyperchromatic nuclei. HSIL corresponds broadly to CIN 2 and CIN 3. Persistent high-risk HPV infection, especially HPV-16 and HPV-18, is the main cause. Robbins, Cotran & Kumar Pathologic Basis of Disease, p. 922.

2. Screening and who should undergo a Pap smear (3 marks)

Screening:
Screening is the examination of apparently healthy, asymptomatic individuals to detect a disease or its precursor lesion at an early, treatable stage. In cervical cancer, exfoliated cells from the transformation zone of the cervix are examined by Pap cytology, HPV testing, or both to identify precancerous squamous intraepithelial lesions before invasive carcinoma develops.
Who should undergo cervical cancer screening?
  • All asymptomatic women with a cervix in the recommended screening age group.
  • A commonly used cytology-based schedule is screening from 21 to 65 years; Pap smear is generally done every 3 years between 21 and 29 years, while women aged 30 to 65 may have cytology, HPV testing, or co-testing according to local guidelines.
  • Women at high risk, such as those with HIV infection, immunosuppression, previous CIN 2/3 or cervical cancer, require earlier and/or more frequent screening.
  • Screening may stop after 65 years in low-risk women with adequate prior negative tests, but not in high-risk women.
For population programmes, WHO recommends high-performance HPV testing as the preferred approach, beginning at age 30 in the general population and at 25 in women living with HIV. WHO screening guidance supports HPV-based screening every 5 to 10 years for the general population.
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