A common clinical dilemma: Management of abnormal vaginal cytology and human papillomavirus test results

• Type of Material: Article
• Authors: Michelle J. Khan, University of Alabama Birmingham; L. Stewart Massad, Washington Univ; Walter Kinney, Permanente Med Grp Inc; Michael A. Gold, Univ Oklahoma; EJ Mayeaux, University of South Carolina; Teresa M. Darragh, University of California San Francisco; Philip E. Castle, Albert Einstein College of Medicine; David Chelmow, Virginia Commonwealth University; Herschel Lawson, Emory University; Warner K. Huh, University of Alabama Birmingham
• Language: English
• Date: 2016-05-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 The Authors.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ygyno.2015.11.023
• Title of Journal or Parent Work: Gynecologic Oncology
• ISSN: 0090-8258
• Volume: 141
• Issue: 2
• Start Page: 364
• End Page: 370
• Grant/Funding Information: LSM (personal fees for review of malpractice cases); TMD (non-financial support from Hologic and honorarium paid to UCSF from Roche, TheVax Genetics, Ventana-Roche); PEC (non-financial support from MTM, BD, Roche, Qiagen, and personal fees from Cepheid, BD, Roche, Inovio, Teva Pharmaceuticals, ClearPath, Merck, Genticel, and GE Healthcare); WKH (personal fees from Merck Vaccines and TheVax).; MJK was supported in this work by grants NCI P50 CA098252 (PI Wu/Huh) and AHRQ K12 HS023009 (PI Saag); this work does not represent the views of either funding agency.
• Keywords: RISK-FACTORS; Oncology; HYSTERECTOMIZED WOMEN; HPV; NATURAL-HISTORY; VaIN; Vaginal cytology; DNA DETECTION; Vaginal cancer; Life Sciences & Biomedicine; Obstetrics & Gynecology; INTRAEPITHELIAL NEOPLASIA; CERVICAL-CANCER; POPULATION; INVASIVE CANCER; Science & Technology; AMERICAN SOCIETY; UNITED-STATES
• Research Categories: Health Sciences, Obstetrics and Gynecology; Health Sciences, Public Health

Abstract

Objective: Vaginal cancer is an uncommon cancer of the lower genital tract, and standardized screening is not recommended. Risk factors for vaginal cancer include a history of other lower genital tract neoplasia or cancer, smoking, immunosuppression, and exposure to diethylstilbestrol in utero. Although cervical cancer screening after total hysterectomy for benign disease is not recommended, many women inappropriately undergo vaginal cytology and/or human papillomavirus (hrHPV) tests, and clinicians are faced with managing their abnormal results. Our objective is to review the literature on vaginal cytology and hrHPV testing and to develop guidance for the management of abnormal vaginal screening tests. Methods An electronic search of the PubMed database through 2015 was performed. Articles describing vaginal cytology or vaginal hrHPV testing were reviewed, and diagnostic accuracy of these tests when available was noted. Results The available literature was too limited to develop evidence-based recommendations for managing abnormal vaginal cytology and hrHPV screening tests. However, the data did show that 1) the risk of vaginal cancer in women after hysterectomy is extremely low, justifying the recommendation against routine screening, and 2) in women for whom surveillance is recommended, e.g. women post-treatment for cervical precancer or cancer, hrHPV testing may be useful in identification of vaginal cancer precursors. Conclusion Vaginal cancer is rare, and asymptomatic low-risk women should not be screened. An algorithm based on expert opinion is proposed for managing women with abnormal vaginal test results.