Pathophysiology of Cervical Cancer and Screening Guidelines

This case study examines the pathophysiology of cervical cancer, focusing on the role of high-risk HPV infection and factors contributing to the disease. The assignment analyzes a case involving a 33-year-old woman, Sarah, highlighting her risk factors such as multiple sexual partners and the use of birth control pills, and her diagnosis of high-grade squamous intraepithelial lesion and severe dysplasia. The document also outlines the latest cervical screening guidelines in Australia, including the shift from a two-year to a five-year screening interval, and provides a scientific rationale for these changes, emphasizing the accuracy of HPV testing and the time frame for HPV infections to develop into cancerous cells. The document includes references to key research articles and guidelines.

Pathophysiology of cervical cancer
HPV infection comes with two major risk factors namely high-risk (HR) HPV and unsuccessful
clearance of the virus. Although most HPV infections disappear by themselves after few months
or years, HR HPV usually transforms the genome sequences which affect the physiology of the
woman hence diverse clinical appearances. According to Johnson, James, Marzan, and Armaos
(2019), in some women, there may be squamous intraepithelial lesions of up to two years after
the clearance of the infection. This then results into an infection of the basal cells between the
columnar epithelium of the endocervix and the squamous epithelium of the ectocervix. The
replication of the viral happens in the cells of the epithelium through the differentiation cycle
where dispatching of genes coding for viral replication factors occur (Salina Zhang, Batur, &
NCMP, 2019). The replication of the HPV DNA starts after the duplication of the DNA of the
basal cells. In Sarah’s case, the risk factors identified are a high lifetime sex partners, and the use
of birth control pills.
Guidelines for Cervical Screening in Australia
Cervical cytology in Australia is a cost-effective screening aimed at minimizing the incidence
and mortality of cervical cancer through detection and consequently treating the precursors.
Currently, the screening guidelines require that the HPV test for partial genotyping should be
undertaken after every 5 years. The cervical screening tests should also be done on vaccinated
and unvaccinated women aged 25 -74 years old. Moreover, the guidelines recommend that
people with deep symptoms should be screened at any age. Although Pap smear is no longer
required, the guidelines still involve the use of a vaginal speculum during examination although
the medium of the sample is liquid-based and tests on the presence of HPV. According to

National Cervical Screening Program (2020), if a patient refuses to screen, an alternative method
of self-selection can be used if the patient meets the eligibility criteria; that is, over 30 years and
has at least 2 years since the last screening. The screening strategies used should fit different
populations within Australia. Since the screening is a risky pathway, women should be screened
as per their risks of developing cervical abnormalities within the next five years.
The screening test has changed from 2 to 5 years because cervical screening test is more accurate
than the previously used Pap smear. Cervical screening tests for the presence of HR HPV
infection in the cervix. Hall et al. (2018) argue that it takes 10-15 years for HPV to turn into
potential high-grade cancerous cells. Therefore, screening after 5 years gives enough time for the
HPV infections to turn into abnormal cells in case they do not clear on their own.
References
Johnson, C. A., James, D., Marzan, A., & Armaos, M. (2019, March). Cervical cancer: an
overview of pathophysiology and management. In Seminars in oncology nursing. WB
Saunders.
Salina Zhang, B. S., Batur, P., & NCMP, C. (2019). Human papillomavirus in 2019: An update
on cervical cancer prevention and screening guidelines. Cleveland Clinic journal of
medicine, 86(3), 173.
National Cervical Screening Program (2020). Information about how the Cervical Screening Test
is done and who should have the test. Australian Government Department of Health.

Retrieved from http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/
Content/about-the-new-test
Hall, M. T., Simms, K. T., Lew, J. B., Smith, M. A., Saville, M., & Canfell, K. (2018). Projected
future impact of HPV vaccination and primary HPV screening on cervical cancer rates
from 2017–2035: example from Australia. PloS one, 13(2).