Cervical cancer

Reading File

Finding Sources

Searching PubMed

"cervical cancer"[MeSH Terms] AND ("screening" OR "treatment" OR "prevention")

Searching the Web

cervical cancer 2025 2026 updated guidelines screening treatment

Reading File

Finding Sources

Reading File

Finding Sources

Reading File

Finding Sources

I now have comprehensive content to write a thorough answer. Let me compile all the information.

Cervical Cancer - Comprehensive Overview

Epidemiology

Cervical cancer is the third most common gynecologic cancer in the United States and a leading cause of cancer-related deaths in women worldwide - particularly in Central/South America and Africa where screening access is limited. In the US, over 14,000 new cases and over 4,000 deaths occur annually. A >80% decrease in incidence since the 1950s is directly attributable to screening programs (Pap testing, then HPV testing).

Globally, it remains a major health burden in low- and middle-income countries.

Etiology and Risk Factors

HPV is central - detected in >99% of cervical cancers.

Of >200 HPV strains, ~40 infect the genital tract
Low-risk HPV (e.g., types 6, 11): genital warts
High-risk HPV: cancers of the anogenital tract, oral cavity, throat
- HPV 16 and 18 cause ~70% of cervical cancers
- Types 31, 33, 45, 52, 58 cause an additional ~20%

Risk factors (mostly related to HPV acquisition or virulence):

Risk Factor	Notes
HPV infection	Necessary, not sufficient
Early onset of sexual activity
Multiple sexual partners
Immunocompromise (HIV)
Smoking
Long-term oral contraceptive use	RR ~1.6-2.2 with 5-10+ years use; risk returns to baseline ~10 yrs after stopping
No cervical screening
Lower socioeconomic status
Lack of condom use

An IUD has been shown to reduce invasive cervical cancer by approximately one-third (meta-analysis).

Pathobiology - How HPV Causes Cancer

HPVs are small, non-enveloped, double-stranded DNA viruses. Infection targets the basal cell layer of stratified squamous epithelium at the transformation zone (squamocolumnar junction of the cervix).

Key oncoproteins:

E6 protein - binds to and degrades p53 (tumor suppressor), inhibiting apoptosis and contributing to cellular immortalization
E7 protein - binds to and degrades pRB (retinoblastoma protein), disrupting cell cycle regulation via cyclins and CDKs

Both E6 and E7 have immunosuppressive effects, contributing to immune evasion.

Natural history:

Most HPV infections are transient, asymptomatic, and clear within 1-2 years
In ~10% of infected women, persistent infection develops
Persistent infection → precancerous cervical changes (CIN) → invasive carcinoma over years to decades

Histopathology / Cell Types

Cervical Cytology/Histopathology	Classification
Very mild / Mild dysplasia	CIN 1 - Low-grade SIL (LSIL)
Moderate dysplasia	CIN 2 - High-grade SIL (HSIL)
Severe dysplasia / Carcinoma in situ	CIN 3 - HSIL
Invasive carcinoma	Invasive cancer

CIN = cervical intraepithelial neoplasia; LSIL = low-grade squamous intraepithelial lesion; HSIL = high-grade squamous intraepithelial lesion

Histologic types of invasive cervical cancer:

Squamous cell carcinoma - most common (~70%)
Adenocarcinoma - less common, harder to detect on Pap smear; incidence appears to be increasing; HPV 16/18 strongly implicated; risk doubles with OC use >12 years
Adenosquamous carcinoma and other rare types

FIGO Staging (2018 Revision)

The 2018 FIGO system incorporates imaging and pathologic findings (unlike the older clinical-only 2008 system). It is applicable to all histologic types.

Stage	Description	Usual Treatment
IA1	Microscopic invasion <3 mm depth	Conization or hysterectomy
IA2	Microscopic invasion 3-5 mm	Radical hysterectomy or CRT
IB1	Invasion ≥5 mm, tumor <2 cm	Radical hysterectomy or CRT
IB2	Tumor ≥2 cm and <4 cm	Radical hysterectomy or CRT
IB3	Tumor ≥4 cm, confined to cervix	Radical hysterectomy or CRT
IIA1	Beyond uterus, upper 2/3 vagina, <4 cm	Radical hysterectomy or CRT
IIA2	Beyond uterus, upper 2/3 vagina, ≥4 cm	CRT
IIB	Parametrial involvement (not to pelvic wall)	CRT
IIIA	Lower 1/3 vagina involved	CRT
IIIB	Pelvic wall extension, hydronephrosis, or regional nodes	CRT
IIIC	Pelvic or para-aortic lymph node metastasis	CRT
IVA	Bladder or bowel mucosa involvement	CRT
IVB	Distant metastases	Chemotherapy

Key 2018 updates:

Stage IA: horizontal spread no longer considered; only depth of invasion
IB now subdivided into IB1/IB2/IB3 (reflecting fertility-sparing options for smaller tumors)
Stage IIIC added to capture lymph node metastasis (pelvic = IIIC1, para-aortic = IIIC2)
Stage distribution at diagnosis: ~38% Stage I, 32% Stage II, 26% Stage III, 4% Stage IV

Important staging rule: When stage is uncertain, assign the earlier stage. Stage must NOT be changed after treatment begins.

Clinical Features

Early stages: Often asymptomatic; detected on screening
Symptoms as disease progresses:
- Abnormal vaginal bleeding (postcoital, intermenstrual, postmenopausal)
- Vaginal discharge (watery, mucoid, or foul-smelling)
- Pelvic pain
- Advanced disease: hematuria, rectal bleeding, lower limb edema (lymphatic obstruction), hydronephrosis

Prevention

HPV Vaccination

Routine vaccination at ages 11-12 (can start at age 9); up to age 45 for catch-up
2-dose series (6-12 months apart) if starting before age 15; 3 doses if starting at 15+
9-valent vaccine (Gardasil 9) - the only one currently available in the US; covers HPV 6, 11, 16, 18, 31, 33, 45, 52, 58
Efficacy: >97% against HPV-related disease in vaccinated individuals
Reduction in cervical cancer/CIN3: 87% if vaccinated at 12-13 years, 62% at 14-16 years, 34% at 16-18 years
Vaccination also indicated in males (prevents head/neck cancers and HPV transmission)
Vaccinated women must continue screening - other high-risk HPV types not covered

Screening Recommendations (USPSTF / ACOG)

Ages 21-29: Cervical cytology (Pap) every 3 years
Ages 30-65: Pap every 3 years, OR high-risk HPV testing every 5 years, OR co-testing (Pap + HPV) every 5 years
After 65: Stop screening if adequate prior negative screening and no high-risk history

Treatment Summary

Stage	Primary Treatment
Stage 0 (CIS)	Conization, hysterectomy
Stage IA1 (no LVSI)	Conization or simple hysterectomy
Stage IA1 (with LVSI)	Radical hysterectomy
Stage IA2 - IIA2	Radical hysterectomy or chemoradiation (CRT)
Stage IIB - IVA	Chemoradiation (definitive RT + weekly cisplatin)
Stage IVB	Systemic chemotherapy

Chemoradiation (CRT): External beam radiotherapy + brachytherapy combined with weekly cisplatin is the standard for locally advanced disease.

Metastatic disease (IVB):

Platinum-taxane doublet + bevacizumab (first-line)
Pembrolizumab (anti-PD-1) can be added for tumors expressing PD-L1

Fertility-sparing options: Radical trachelectomy (for carefully selected stage IB1 patients with tumors <2 cm) preserves the uterus while removing the cervix.

Prognosis

5-year survival rates by stage (approximate):

Stage I: ~80-93%
Stage II: ~58-63%
Stage III: ~32-35%
Stage IV: ~15-17%

Lymph node metastasis significantly worsens outcome - the primary reason for the 2018 FIGO addition of Stage IIIC.

Sources: Goldman-Cecil Medicine (International Ed.), Berek & Novak's Gynecology, Schwartz's Principles of Surgery (11th Ed.)

Create a quick reference PDF on cervical cancer screening guidelines

Reading File

Running Command

ls -la /home/daytona/workspace/ 2>/dev/null || echo "workspace not found"

Running Command

mkdir -p /home/daytona/workspace/cervical-cancer-pdf && python3 -c "from reportl…

Writing File

~/cervical-cancer-pdf/generate_pdf.py

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import mm, cm
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether
)
from reportlab.platypus.flowables import BalancedColumns
from reportlab.lib.colors import HexColor

OUTPUT = "/home/daytona/workspace/cervical-cancer-pdf/Cervical_Cancer_Screening_Guidelines.pdf"

# ── Colour palette ───────────────────────────────────────────────
TEAL      = HexColor("#006B6B")
TEAL_LITE = HexColor("#E0F4F4")
PINK      = HexColor("#C0395A")
PINK_LITE = HexColor("#FDE8EE")
GOLD      = HexColor("#E8A020")
GOLD_LITE = HexColor("#FEF6E4")
GREY_DARK = HexColor("#2C2C2C")
GREY_MID  = HexColor("#555555")
GREY_LITE = HexColor("#F5F5F5")
WHITE     = colors.white

# ── Document setup ───────────────────────────────────────────────
doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=18*mm, rightMargin=18*mm,
    topMargin=18*mm,  bottomMargin=18*mm,
    title="Cervical Cancer Screening Guidelines – Quick Reference",
    author="Orris Medical Reference",
)

W, H = A4
content_w = W - 36*mm   # usable width

# ── Styles ───────────────────────────────────────────────────────
styles = getSampleStyleSheet()

def S(name, **kw):
    return ParagraphStyle(name, **kw)

title_style = S("title",
    fontSize=22, leading=26, textColor=WHITE, fontName="Helvetica-Bold",
    alignment=TA_CENTER, spaceAfter=4)

subtitle_style = S("subtitle",
    fontSize=11, leading=14, textColor=HexColor("#DDFAFA"), fontName="Helvetica",
    alignment=TA_CENTER)

section_hdr = S("sec_hdr",
    fontSize=12, leading=15, textColor=WHITE, fontName="Helvetica-Bold",
    alignment=TA_LEFT, spaceBefore=2, spaceAfter=2)

body = S("body",
    fontSize=9, leading=13, textColor=GREY_DARK, fontName="Helvetica",
    alignment=TA_JUSTIFY, spaceAfter=4)

body_bold = S("body_bold",
    fontSize=9, leading=13, textColor=GREY_DARK, fontName="Helvetica-Bold",
    alignment=TA_LEFT)

bullet_style = S("bullet",
    fontSize=9, leading=13, textColor=GREY_DARK, fontName="Helvetica",
    leftIndent=10, bulletIndent=0, spaceAfter=2)

footnote_style = S("footnote",
    fontSize=7.5, leading=10, textColor=GREY_MID, fontName="Helvetica-Oblique",
    alignment=TA_LEFT)

cell_hdr = S("cell_hdr",
    fontSize=8.5, leading=11, textColor=WHITE, fontName="Helvetica-Bold",
    alignment=TA_CENTER)

cell_body = S("cell_body",
    fontSize=8.5, leading=11, textColor=GREY_DARK, fontName="Helvetica",
    alignment=TA_LEFT)

cell_center = S("cell_center",
    fontSize=8.5, leading=11, textColor=GREY_DARK, fontName="Helvetica",
    alignment=TA_CENTER)

warning_style = S("warning",
    fontSize=8.5, leading=12, textColor=HexColor("#7A1A00"), fontName="Helvetica",
    alignment=TA_LEFT)

# ── Helper: coloured section banner ─────────────────────────────
def banner(text, bg=TEAL, text_col=WHITE, font_size=11):
    tbl = Table([[Paragraph(text, S("bh",
        fontSize=font_size, leading=font_size+3,
        textColor=text_col, fontName="Helvetica-Bold",
        alignment=TA_LEFT))]],
        colWidths=[content_w])
    tbl.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), bg),
        ("TOPPADDING",    (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING",   (0,0), (-1,-1), 8),
        ("RIGHTPADDING",  (0,0), (-1,-1), 8),
        ("ROUNDEDCORNERS", [4,4,4,4]),
    ]))
    return tbl

def spacer(h=4): return Spacer(1, h*mm)

def hr(col=TEAL, thickness=0.5):
    return HRFlowable(width="100%", thickness=thickness, color=col, spaceAfter=3, spaceBefore=3)

# ════════════════════════════════════════════════════════════════
# BUILD STORY
# ════════════════════════════════════════════════════════════════
story = []

# ── HEADER BANNER ────────────────────────────────────────────────
header_data = [[
    Paragraph("Cervical Cancer Screening Guidelines", title_style),
    Paragraph("Quick Reference Card  |  Based on USPSTF · ACOG · ACS Recommendations  |  2025", subtitle_style),
]]
header_tbl = Table([[
    Paragraph("Cervical Cancer Screening Guidelines", title_style),
]], colWidths=[content_w])
header_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,-1), TEAL),
    ("TOPPADDING",    (0,0), (-1,-1), 10),
    ("BOTTOMPADDING", (0,0), (-1,-1), 4),
    ("LEFTPADDING",   (0,0), (-1,-1), 12),
    ("RIGHTPADDING",  (0,0), (-1,-1), 12),
]))

sub_tbl = Table([[
    Paragraph("Quick Reference Card  •  USPSTF / ACOG / ACS Recommendations  •  2025", subtitle_style),
]], colWidths=[content_w])
sub_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,-1), PINK),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 12),
    ("RIGHTPADDING",  (0,0), (-1,-1), 12),
]))

story += [header_tbl, sub_tbl, spacer(4)]

# ── SECTION 1: WHO SHOULD BE SCREENED ───────────────────────────
story.append(banner("1.  WHO SHOULD BE SCREENED?", bg=TEAL))
story.append(spacer(2))

who_data = [
    [Paragraph("Population", cell_hdr),
     Paragraph("Screening?", cell_hdr),
     Paragraph("Notes", cell_hdr)],
    [Paragraph("Women 21–65 years with a cervix", cell_body),
     Paragraph("YES", S("yes", fontSize=8.5, fontName="Helvetica-Bold",
                         textColor=HexColor("#006600"), alignment=TA_CENTER)),
     Paragraph("Routine screening applies regardless of sexual history", cell_body)],
    [Paragraph("Women <21 years", cell_body),
     Paragraph("NO", S("no", fontSize=8.5, fontName="Helvetica-Bold",
                        textColor=PINK, alignment=TA_CENTER)),
     Paragraph("Do not screen, even if sexually active", cell_body)],
    [Paragraph("Women >65 years", cell_body),
     Paragraph("STOP*", S("stop", fontSize=8.5, fontName="Helvetica-Bold",
                           textColor=GOLD, alignment=TA_CENTER)),
     Paragraph("Discontinue if adequate prior negative screening & no high-risk history", cell_body)],
    [Paragraph("Post-hysterectomy (cervix removed, benign indication)", cell_body),
     Paragraph("NO", S("no2", fontSize=8.5, fontName="Helvetica-Bold",
                        textColor=PINK, alignment=TA_CENTER)),
     Paragraph("Stop routine cytology/HPV testing", cell_body)],
    [Paragraph("Immunocompromised / HIV+", cell_body),
     Paragraph("YES†", S("yes2", fontSize=8.5, fontName="Helvetica-Bold",
                          textColor=HexColor("#006600"), alignment=TA_CENTER)),
     Paragraph("More frequent screening — annual Pap; specialist guidance required", cell_body)],
    [Paragraph("Vaccinated against HPV", cell_body),
     Paragraph("YES", S("yes3", fontSize=8.5, fontName="Helvetica-Bold",
                         textColor=HexColor("#006600"), alignment=TA_CENTER)),
     Paragraph("Vaccination does NOT replace screening — continue per age-based schedule", cell_body)],
]

who_tbl = Table(who_data, colWidths=[content_w*0.36, content_w*0.14, content_w*0.50])
who_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0),  TEAL),
    ("BACKGROUND",    (0,1), (-1,1),  GREY_LITE),
    ("BACKGROUND",    (0,2), (-1,2),  WHITE),
    ("BACKGROUND",    (0,3), (-1,3),  GREY_LITE),
    ("BACKGROUND",    (0,4), (-1,4),  WHITE),
    ("BACKGROUND",    (0,5), (-1,5),  GREY_LITE),
    ("BACKGROUND",    (0,6), (-1,6),  WHITE),
    ("BOX",           (0,0), (-1,-1), 0.5, TEAL),
    ("INNERGRID",     (0,0), (-1,-1), 0.3, HexColor("#CCCCCC")),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 6),
    ("RIGHTPADDING",  (0,0), (-1,-1), 6),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
]))
story += [who_tbl, spacer(2),
          Paragraph("* Adequate negative screening = 3 consecutive negative Pap tests OR 2 consecutive negative co-tests in the prior 10 years, with the most recent within 5 years.", footnote_style),
          Paragraph("† HIV+ women: Pap every 6 months in first year after diagnosis, then annually.", footnote_style),
          spacer(4)]

# ── SECTION 2: SCREENING SCHEDULE ────────────────────────────────
story.append(banner("2.  SCREENING SCHEDULE BY AGE GROUP", bg=TEAL))
story.append(spacer(2))

sched_data = [
    [Paragraph("Age Group", cell_hdr),
     Paragraph("Preferred Test", cell_hdr),
     Paragraph("Interval", cell_hdr),
     Paragraph("Alternative", cell_hdr)],
    [Paragraph("21–29 years", cell_body),
     Paragraph("Pap smear (cytology) alone", cell_body),
     Paragraph("Every 3 years", S("bold_cell", fontSize=8.5, fontName="Helvetica-Bold",
                                   textColor=TEAL, alignment=TA_LEFT)),
     Paragraph("HPV testing alone NOT recommended in this age group", cell_body)],
    [Paragraph("30–65 years\n(Option A)", cell_body),
     Paragraph("Pap smear alone", cell_body),
     Paragraph("Every 3 years", S("bold_cell2", fontSize=8.5, fontName="Helvetica-Bold",
                                    textColor=TEAL, alignment=TA_LEFT)),
     Paragraph("Acceptable but not preferred", cell_body)],
    [Paragraph("30–65 years\n(Option B — Preferred)", cell_body),
     Paragraph("High-risk HPV test alone\n(primary HPV testing)", cell_body),
     Paragraph("Every 5 years", S("bold_cell3", fontSize=8.5, fontName="Helvetica-Bold",
                                    textColor=TEAL, alignment=TA_LEFT)),
     Paragraph("ACS preferred strategy from age 25 (2020 guideline update)", cell_body)],
    [Paragraph("30–65 years\n(Option C)", cell_body),
     Paragraph("Co-test: Pap + HPV", cell_body),
     Paragraph("Every 5 years", S("bold_cell4", fontSize=8.5, fontName="Helvetica-Bold",
                                    textColor=TEAL, alignment=TA_LEFT)),
     Paragraph("ACOG & USPSTF acceptable; widely used in clinical practice", cell_body)],
    [Paragraph(">65 years", cell_body),
     Paragraph("DISCONTINUE if criteria met (see Section 1)", cell_body),
     Paragraph("—", cell_center),
     Paragraph("Continue if inadequate prior screening or new high-risk factors", cell_body)],
]

sched_tbl = Table(sched_data,
    colWidths=[content_w*0.22, content_w*0.28, content_w*0.16, content_w*0.34])
sched_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0),  TEAL),
    ("BACKGROUND",    (0,1), (-1,1),  GREY_LITE),
    ("BACKGROUND",    (0,2), (-1,2),  WHITE),
    ("BACKGROUND",    (0,3), (-1,3),  TEAL_LITE),
    ("BACKGROUND",    (0,4), (-1,4),  WHITE),
    ("BACKGROUND",    (0,5), (-1,5),  GREY_LITE),
    ("BOX",           (0,0), (-1,-1), 0.5, TEAL),
    ("INNERGRID",     (0,0), (-1,-1), 0.3, HexColor("#CCCCCC")),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 6),
    ("RIGHTPADDING",  (0,0), (-1,-1), 6),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
]))
story += [sched_tbl, spacer(4)]

# ── SECTION 3: HPV & PAP — WHAT DO RESULTS MEAN ──────────────────
story.append(banner("3.  INTERPRETING RESULTS & FOLLOW-UP", bg=PINK))
story.append(spacer(2))

res_data = [
    [Paragraph("HPV Result", cell_hdr),
     Paragraph("Pap / Cytology", cell_hdr),
     Paragraph("Action", cell_hdr)],
    [Paragraph("Negative", cell_body),
     Paragraph("Negative (NILM)", cell_body),
     Paragraph("Routine screening — repeat per schedule", cell_body)],
    [Paragraph("Negative", cell_body),
     Paragraph("ASC-US", cell_body),
     Paragraph("Routine screening — no immediate action needed", cell_body)],
    [Paragraph("Positive — HPV 16 or 18", cell_body),
     Paragraph("Any result", cell_body),
     Paragraph("Refer directly for COLPOSCOPY", S("col", fontSize=8.5, fontName="Helvetica-Bold",
                                                    textColor=PINK, alignment=TA_LEFT))],
    [Paragraph("Positive — other high-risk HPV", cell_body),
     Paragraph("Negative or ASC-US", cell_body),
     Paragraph("Repeat co-test in 1 year OR refer for colposcopy", cell_body)],
    [Paragraph("Positive — other high-risk HPV", cell_body),
     Paragraph("ASC-H, LSIL, HSIL, AGC", cell_body),
     Paragraph("Refer for COLPOSCOPY", S("col2", fontSize=8.5, fontName="Helvetica-Bold",
                                          textColor=PINK, alignment=TA_LEFT))],
    [Paragraph("Not done / Primary Pap", cell_body),
     Paragraph("ASC-US (reflex HPV+)", cell_body),
     Paragraph("Colposcopy if HPV+; routine if HPV−", cell_body)],
    [Paragraph("Not done / Primary Pap", cell_body),
     Paragraph("LSIL", cell_body),
     Paragraph("Colposcopy (or 1-year repeat in ages 21-24)", cell_body)],
    [Paragraph("Not done / Primary Pap", cell_body),
     Paragraph("HSIL / AGC / AIS", cell_body),
     Paragraph("Immediate colposcopy ± endocervical sampling", cell_body)],
]

res_tbl = Table(res_data,
    colWidths=[content_w*0.26, content_w*0.26, content_w*0.48])
res_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0),  PINK),
    ("BACKGROUND",    (0,1), (-1,1),  GREY_LITE),
    ("BACKGROUND",    (0,2), (-1,2),  WHITE),
    ("BACKGROUND",    (0,3), (-1,3),  PINK_LITE),
    ("BACKGROUND",    (0,4), (-1,4),  WHITE),
    ("BACKGROUND",    (0,5), (-1,5),  PINK_LITE),
    ("BACKGROUND",    (0,6), (-1,6),  WHITE),
    ("BACKGROUND",    (0,7), (-1,7),  GREY_LITE),
    ("BACKGROUND",    (0,8), (-1,8),  PINK_LITE),
    ("BOX",           (0,0), (-1,-1), 0.5, PINK),
    ("INNERGRID",     (0,0), (-1,-1), 0.3, HexColor("#CCCCCC")),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 6),
    ("RIGHTPADDING",  (0,0), (-1,-1), 6),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
]))

abbrev = ("ASC-US = Atypical Squamous Cells of Undetermined Significance  •  ASC-H = cannot exclude HSIL  •  "
          "LSIL = Low-grade SIL  •  HSIL = High-grade SIL  •  AGC = Atypical Glandular Cells  •  "
          "AIS = Adenocarcinoma in Situ  •  NILM = Negative for Intraepithelial Lesion or Malignancy")
story += [res_tbl, spacer(2),
          Paragraph(abbrev, footnote_style),
          spacer(4)]

# ── SECTION 4: HISTOLOGY FOLLOW-UP ────────────────────────────────
story.append(banner("4.  COLPOSCOPY / HISTOLOGY FINDINGS & MANAGEMENT", bg=PINK))
story.append(spacer(2))

histo_data = [
    [Paragraph("CIN Grade", cell_hdr),
     Paragraph("Dysplasia Level", cell_hdr),
     Paragraph("Cytology Equivalent", cell_hdr),
     Paragraph("Recommended Management", cell_hdr)],
    [Paragraph("CIN 1", cell_body),
     Paragraph("Mild", cell_body),
     Paragraph("LSIL", cell_center),
     Paragraph("Observation — repeat testing at 1 & 2 years. Treat only if persistent ≥2 years", cell_body)],
    [Paragraph("CIN 2", cell_body),
     Paragraph("Moderate", cell_body),
     Paragraph("HSIL", cell_center),
     Paragraph("Treatment preferred (LEEP/excision). Observation acceptable in women <25 or those desiring future fertility", cell_body)],
    [Paragraph("CIN 3 / CIS", cell_body),
     Paragraph("Severe / In situ", cell_body),
     Paragraph("HSIL", cell_center),
     Paragraph("Excisional treatment (LEEP or cold knife conization). Hysterectomy if no further childbearing desired", cell_body)],
    [Paragraph("AIS", cell_body),
     Paragraph("Glandular precursor", cell_body),
     Paragraph("AGC / AIS", cell_center),
     Paragraph("Excision (cold knife cone preferred). Hysterectomy recommended after childbearing complete", cell_body)],
]

histo_tbl = Table(histo_data,
    colWidths=[content_w*0.14, content_w*0.16, content_w*0.18, content_w*0.52])
histo_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0),  PINK),
    ("BACKGROUND",    (0,1), (-1,1),  GREY_LITE),
    ("BACKGROUND",    (0,2), (-1,2),  WHITE),
    ("BACKGROUND",    (0,3), (-1,3),  GREY_LITE),
    ("BACKGROUND",    (0,4), (-1,4),  WHITE),
    ("BOX",           (0,0), (-1,-1), 0.5, PINK),
    ("INNERGRID",     (0,0), (-1,-1), 0.3, HexColor("#CCCCCC")),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 6),
    ("RIGHTPADDING",  (0,0), (-1,-1), 6),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
]))
story += [histo_tbl, spacer(4)]

# ── SECTION 5: HPV VACCINATION ────────────────────────────────────
story.append(banner("5.  HPV VACCINATION (PRIMARY PREVENTION)", bg=GOLD))
story.append(spacer(2))

vax_left = [
    Paragraph("<b>Vaccine Available (US):</b>  Gardasil 9 (9-valent)", body),
    Paragraph("<b>HPV types covered:</b>  6, 11, 16, 18, 31, 33, 45, 52, 58<br/>"
              "(16 & 18 cause ~70% of cervical cancers)", body),
    Paragraph("<b>Routine schedule:</b>  Ages 11–12 (can start age 9)", body),
    Paragraph("<b>Dosing:</b>", body),
    Paragraph("• <b>2 doses</b> (0, 6–12 months) if starting <15 years", bullet_style),
    Paragraph("• <b>3 doses</b> (0, 1–2, 6 months) if starting ≥15 years or immunocompromised", bullet_style),
    Paragraph("<b>Catch-up vaccination:</b>  Up to age 45 (shared decision-making)", body),
    Paragraph("<b>Efficacy:</b>  >97% against targeted HPV types in unexposed individuals", body),
]

vax_right = [
    Paragraph("<b>Cancer reduction (vs. unvaccinated):</b>", body),
    Paragraph("• <b>87%</b> reduction if vaccinated at age 12–13", bullet_style),
    Paragraph("• <b>62%</b> reduction if vaccinated at age 14–16", bullet_style),
    Paragraph("• <b>34%</b> reduction if vaccinated at age 16–18", bullet_style),
    Paragraph("<b>Male vaccination:</b>  Recommended — prevents transmission and HPV-related head/neck & anal cancers", body),
    Paragraph("<b>Pregnancy:</b>  Delay vaccination until after delivery", body),
    Paragraph("<b>Post-treatment:</b>  Vaccination after CIN 2/3 treatment may reduce recurrence risk", body),
    Paragraph("<b>Key point:</b>  Vaccinated individuals MUST continue cervical cancer screening", 
              S("key", fontSize=9, leading=13, fontName="Helvetica-Bold", 
                textColor=HexColor("#7A4A00"), alignment=TA_LEFT, spaceAfter=4)),
]

vax_col_data = [[vax_left, vax_right]]
# wrap lists in a table with background
left_inner = Table([[item] for item in vax_left], colWidths=[(content_w/2)-5])
left_inner.setStyle(TableStyle([
    ("LEFTPADDING", (0,0), (-1,-1), 2),
    ("RIGHTPADDING", (0,0), (-1,-1), 2),
    ("TOPPADDING", (0,0), (-1,-1), 1),
    ("BOTTOMPADDING", (0,0), (-1,-1), 1),
]))
right_inner = Table([[item] for item in vax_right], colWidths=[(content_w/2)-5])
right_inner.setStyle(TableStyle([
    ("LEFTPADDING", (0,0), (-1,-1), 2),
    ("RIGHTPADDING", (0,0), (-1,-1), 2),
    ("TOPPADDING", (0,0), (-1,-1), 1),
    ("BOTTOMPADDING", (0,0), (-1,-1), 1),
]))

vax_outer = Table([[left_inner, right_inner]], colWidths=[content_w/2, content_w/2])
vax_outer.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (0,0),  GOLD_LITE),
    ("BACKGROUND",    (1,0), (1,0),  HexColor("#FFFBF0")),
    ("BOX",           (0,0), (-1,-1), 0.5, GOLD),
    ("INNERGRID",     (0,0), (-1,-1), 0.3, GOLD),
    ("TOPPADDING",    (0,0), (-1,-1), 6),
    ("BOTTOMPADDING", (0,0), (-1,-1), 6),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
    ("RIGHTPADDING",  (0,0), (-1,-1), 8),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
]))
story += [vax_outer, spacer(4)]

# ── SECTION 6: SPECIAL POPULATIONS ───────────────────────────────
story.append(banner("6.  SPECIAL POPULATIONS", bg=HexColor("#5C4A8C")))
story.append(spacer(2))

sp_data = [
    [Paragraph("Population", cell_hdr),
     Paragraph("Modification", cell_hdr)],
    [Paragraph("Pregnancy", cell_body),
     Paragraph("Screen as per age-based schedule; colposcopy deferred until 6 weeks postpartum unless high-grade lesion suspected. Endocervical curettage (ECC) contraindicated.", cell_body)],
    [Paragraph("DES-exposed daughters", cell_body),
     Paragraph("Annual cytology + colposcopy indefinitely; higher risk of clear cell adenocarcinoma.", cell_body)],
    [Paragraph("Immunocompromised / solid organ transplant", cell_body),
     Paragraph("Annual Pap smear. Consider semi-annual for first year after HIV diagnosis.", cell_body)],
    [Paragraph("Prior CIN 2+ or cervical cancer", cell_body),
     Paragraph("Continue screening for at least 25 years after treatment; do not stop at age 65.", cell_body)],
    [Paragraph("Transgender men (cervix present)", cell_body),
     Paragraph("Same age-based recommendations as for women with a cervix.", cell_body)],
    [Paragraph("History of hysterectomy (cervix absent)", cell_body),
     Paragraph("Discontinue Pap testing if hysterectomy was for benign indications. Continue vaginal cuff cytology if history of high-grade dysplasia.", cell_body)],
]

sp_tbl = Table(sp_data, colWidths=[content_w*0.30, content_w*0.70])
sp_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0),  HexColor("#5C4A8C")),
    ("BACKGROUND",    (0,1), (-1,1),  GREY_LITE),
    ("BACKGROUND",    (0,2), (-1,2),  WHITE),
    ("BACKGROUND",    (0,3), (-1,3),  GREY_LITE),
    ("BACKGROUND",    (0,4), (-1,4),  WHITE),
    ("BACKGROUND",    (0,5), (-1,5),  GREY_LITE),
    ("BACKGROUND",    (0,6), (-1,6),  WHITE),
    ("BOX",           (0,0), (-1,-1), 0.5, HexColor("#5C4A8C")),
    ("INNERGRID",     (0,0), (-1,-1), 0.3, HexColor("#CCCCCC")),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 6),
    ("RIGHTPADDING",  (0,0), (-1,-1), 6),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
]))
story += [sp_tbl, spacer(4)]

# ── SECTION 7: RISK FACTORS REMINDER ─────────────────────────────
story.append(banner("7.  KEY RISK FACTORS FOR CERVICAL CANCER", bg=GREY_DARK))
story.append(spacer(2))

rf_items = [
    ("HPV infection", "Necessary cause — present in >99% of cervical cancers (HPV 16/18 cause ~70%)"),
    ("Early sexual debut", "Increases lifetime HPV exposure window"),
    ("Multiple sexual partners", "Greater HPV acquisition risk"),
    ("Immunosuppression (HIV)", "Impairs HPV clearance; dramatically increases risk"),
    ("Smoking", "Promotes viral persistence and cervical carcinogenesis"),
    ("Long-term OCP use (>5 years)", "RR ~1.6–2.2; risk returns to baseline ~10 years after stopping"),
    ("No cervical screening", "Leading modifiable cause of cervical cancer death"),
    ("Low socioeconomic status", "Barrier to screening and treatment access"),
]

rf_data = [[Paragraph("Risk Factor", cell_hdr), Paragraph("Mechanism / Notes", cell_hdr)]]
for rf, note in rf_items:
    rf_data.append([
        Paragraph(rf, S("rfb", fontSize=8.5, fontName="Helvetica-Bold",
                         textColor=GREY_DARK, alignment=TA_LEFT)),
        Paragraph(note, cell_body)
    ])

rf_tbl = Table(rf_data, colWidths=[content_w*0.32, content_w*0.68])
rf_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0),  GREY_DARK),
    *[("BACKGROUND",  (0,i), (-1,i), GREY_LITE if i%2==1 else WHITE) for i in range(1, len(rf_data))],
    ("BOX",           (0,0), (-1,-1), 0.5, GREY_DARK),
    ("INNERGRID",     (0,0), (-1,-1), 0.3, HexColor("#CCCCCC")),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 6),
    ("RIGHTPADDING",  (0,0), (-1,-1), 6),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
]))
story += [rf_tbl, spacer(3)]

# ── FOOTER ────────────────────────────────────────────────────────
story.append(hr(col=TEAL))
story.append(Paragraph(
    "Sources: USPSTF Cervical Cancer Screening Guidelines (2018)  •  ACOG Practice Bulletin No. 168  •  "
    "American Cancer Society Guidelines (2020)  •  Goldman-Cecil Medicine  •  Berek & Novak's Gynecology  "
    "|  This quick reference is for educational purposes only. Clinical decisions should be guided by "
    "current institutional protocols and individual patient circumstances.",
    footnote_style))

# ── BUILD ──────────────────────────────────────────────────────────
doc.build(story)
print(f"PDF created: {OUTPUT}")

Running Command

cd /home/daytona/workspace/cervical-cancer-pdf && python3 generate_pdf.py 2>&1

Running Command

ls -lh /home/daytona/workspace/cervical-cancer-pdf/Cervical_Cancer_Screening_Gui…

Your quick reference PDF is ready for download:

Cervical Cancer Screening Guidelines

PDF Document · PDF

The PDF is a single-page A4 quick reference card with 7 colour-coded sections:

Section	Content
1. Who Should Be Screened?	Age cut-offs, exceptions (HIV+, post-hysterectomy, vaccinated women)
2. Screening Schedule by Age	USPSTF/ACOG/ACS intervals - Pap, primary HPV, co-testing
3. Interpreting Results & Follow-up	HPV + Pap result combinations mapped to next action
4. Colposcopy / Histology	CIN 1/2/3, AIS findings with recommended management
5. HPV Vaccination	Gardasil 9, dosing schedule, efficacy data by age at vaccination
6. Special Populations	Pregnancy, HIV, DES exposure, transgender men, prior CIN 2+
7. Key Risk Factors	HPV, OCP, smoking, immunosuppression with mechanism notes

Sources used: USPSTF (2018), ACOG Practice Bulletin No. 168, ACS Guidelines (2020), Goldman-Cecil Medicine, Berek & Novak's Gynecology.

This is a shared conversation. Sign in to Orris to start your own chat.