Screening and management of women and girls with human papillomavirus infection

In the US, reductions in cervical cancer-related mortality over the past five decades can be attributed to the implementation of screening programs. US-based guidelines recommend that screening should be initiated approximately 3 years after initiation of sexual intercourse, but no later than age 21 years and be continued at least until age 65 or 70. Annual screening is recommended by the American Cancer Society and the American College of Obstetricians and Gynecologists, although in women aged >= 30 years with >= 3 negative Pap tests, screening may be conducted every 2 to 3 years. Human papillomavirus (HPV) testing has been approved by the US Food and Drug Administration and most US guidelines say that it is reasonable to consider HPV testing, in combination with triennial cytology screening. Pharmacoeconomic analyses indicate that combined cytology and HPV testing every three years in women aged >= 30 years is comparable in sensitivity to annual liquid-based cytology for the detection of cervical cancer precursors and is more cost-effective. Both surgical and nonsurgical therapies are commonly employed in patients with HPV lesions although papilloma recurrence is not uncommon. Treatment should be individualized based on the extent of disease and the needs of the patient. Current treatment of cervical cancer reflects the stage of the disease and should take into account patient-and tumor-related factors to ensure optimal patient outcomes. (C) 2007 Elsevier Inc. All rights reserved.