Makindo Medical Notes

Purpose of screening: The NHS cervical screening programme detects high-risk human papillomavirus (hrHPV) and cellular changes (dyskaryosis) that may lead to cervical cancer if untreated.

🔍 Background

• Primary hrHPV testing is performed on all samples; cytology is only examined if hrHPV is detected.
• Persistent hrHPV produces viral oncoproteins (E6, E7) → inactivation of tumour suppressors (p53, Rb).
• This drives the pathway CIN1 → CIN2 → CIN3 → carcinoma in situ → invasive cancer.

📊 Types of Abnormal Results

1. HPV Negative → routine recall (3-yearly age 25–49, 5-yearly age 50–64).
2. HPV Positive, Cytology Negative → repeat test in 12 months; persistent positivity → colposcopy.
3. HPV Positive + Abnormal Cytology → direct referral to colposcopy.
   • Borderline or low-grade dyskaryosis → often CIN1.
   • High-grade dyskaryosis (moderate or severe) → usually CIN2/3.
   • Suspicious of glandular neoplasia or invasion → urgent colposcopy.

🧬 Pathophysiology

HPV 16 and 18 integrate into host DNA. Viral oncoproteins disrupt normal cell-cycle control, leading to dysregulated proliferation. Without immune clearance, progressive CIN may evolve over years into invasive squamous carcinoma.

🩺 Management Principles

• Colposcopy is used for visual assessment and directed biopsy.
• CIN1 is often observed as many regress spontaneously.
• CIN2/3 usually requires excision with LLETZ.
• All treated women have a “test of cure” (HPV + cytology) at 6 months.

🇬🇧 UK Practical Context

• Offered to women and people with a cervix aged 25–64.
• 25–49 years: every 3 years; 50–64 years: every 5 years.
• HPV vaccination is expected to reduce future rates of abnormal smears and CIN.

✨ Key Learning Points

• An abnormal smear is not cancer but signals increased risk.
• Persistent hrHPV is the critical driver of progression.
• Screening + vaccination together offer strong protection against cervical cancer.