432 Obstetrics and Gynecology Board Review •••
❍ Should all women who have not undergone hysterectomy have Pap smears performed annually?
After initiation of screening, American Cancer Society recommends cervical screening be done annually with
conventional cervical cytology smears or every 2 years using liquid-based cytology. ACOG recommends every
2 years screening regardless of the type of Pap performed. After age 30, women who have had three consecutive,
technically satisfactory normal cytology results may be screened every 3 years (unless DES history, HIV positive, or
are immunocompromised).
❍ How effective have Pap smears been in reducing the incidence of cervical cancer?
Since the development of cytological screening in the 1940s, the incidence of cervical cancer in the United States
has fallen by almost 80%. In contrast, cervical cancer remains the major cause of cancer-related deaths among
women in many third world countries where Pap smears are not routinely performed.
❍ What type of cervical cancer is caused by HPV 18 infections?
Most of the squamous cell carcinomas.
❍ What type of cervical cancer is caused by HPV 16 infections?
Most of the cervical adenocarcinomas.
❍ What is the false-negative rate for conventional Pap smears?
Up to 30% to 40%.
❍ The quadrivalent HPV vaccine should be given to females in what age group?
The FDA approved the vaccine for administration to girls and women between 9 and 26 years of age.
❍ The quadrivalent HPV vaccine should be given to males in what age group?
The FDA did not approve the vaccine for administration to boys and men in any age group.
❍ The HPV vaccine is effective against the oncogenic types 16 and 18. What percentage of cervical cancers
is caused by these two types of HPV?
HPV types 16 and 18 are responsible for about 70% of all cervical cancers.
❍ What is the most common presenting symptom for patients with cervical cancer?
The classic symptoms are intermittent painless metrorrhagia or spotting. Up to 80% of patients present with
abnormal vaginal bleeding, most commonly postmenopausal. Only 10% note postcoital bleeding. Less frequent
symptoms include vaginal discharge and pain. Late symptoms or indicative for more advanced disease are pain
referred to flank or leg, dysuria, hematuria, and rectal bleeding.
❍ What is the most appropriate management for a gross cervical lesion discovered during a routine examination?
Biopsy. Specimens from ulcerated lesions should be obtained from their center.
❍ What is the next appropriate step in management of an ASCUS Pap test in a patient whose reflex HPV
testing is positive for high-risk HPV subtypes?
Colposcopy including cervical biopsy and endocervical curettage.