Page 12 - Screening for Cervical Cancer: Systematic Evidence Review

Chapter I. Introduction

Uniform Terminology for Cervical Lesions

Figure 1 depicts the relationship between varied systems of nomenclature for describing

cytologic and histologic findings. In this report we use terminology from the Bethesda System

— low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial

lesion (HSIL) to describe cytology findings. When possible, we use the cervical intraepithelial

neoplasia (CIN)—specifically, categories CIN 1-3—to refer to histologic findings. As

necessary, we present histology findings for the groupings LSIL or HSIL if this is the most

detailed summary of results provided by the investigators.

Burden of Suffering

In the United States, approximately 12,800 new cases of cervical cancer are diagnosed

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and 4,800 deaths occur each year. Incidence of cervical cancer is decreasing; US rates have

decreased from 14.2 new cases per 100,000 women in 1973 to 7.8 per 100,000 in 1994. For each

woman with invasive disease, there will be 4 with carcinoma in situ and 10 with cervical

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dysplasia. Despite falling incidence, cervical cancer remains the ninth most common cause of
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cancer deaths. Of the cancer prevention goals established in Healthy People 2000, including

colorectal, lung, and breast cancer, cervical cancer mortality rates were the furthest off target at

the mid-course review. The target for cervical cancer was reduction of mortality to 1.3 deaths

per 100,000 women; the current rate remains near 2.7 deaths per 100,000, down only slightly

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from 2.8 per 100,000 in 1987.
Detection of cervical cancer in its earliest stages is lifesaving, as survival of cancer of the

cervix uteri depends heavily on stage at diagnosis. Although 91.5% of women will survive 5

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years when the cancer is localized, only 12.6% will survive distant disease.

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