Among the major factors that influence prognosis are stage, volume and grade of tumor, histologic type, lymphatic spread, and vascular invasion.

Human immunodeficiency virus-infected women have more aggressive and advanced disease and a poorer prognosis.

New Test for Cervical Cancer

Wiping a woman's cervix with vinegar appears to be an
accurate way to detect precancerous tissue that can lead to
cervical cancer. Researchers say the test could be very
useful in countries where the more common Pap smear test is
not available.
Researchers from Johns Hopkins Medical Institutions in
Baltimore and the University of Zimbabwe had nurse-midwives
screen 8,713 African women for cervical cancer using both
the Pap smear and the vinegar test. Colposcopy, in which
cells are placed under high-power magnification, and, when
needed, biopsy were used to confirm abnormal results from
the Pap smear or vinegar test. After wiping the cervix,
nurse-midwives inspected it to check for precancerous
cells, which turn white when exposed to vinegar.
Researchers say the vinegar test detected more than 75
percent of potential cancers among patients.
"This technique easily could be used by health-care workers
in areas with limited resources," says researcher Dr. Paul
D. Blumenthal. "The test is safe, affordable and effective,
and can help health-care workers make an on-the-spot
decision as to whether the patient may need further
attention."
The study is published in the March 13 issue of The
Lancet.

Molecular techniques for the identification of human papillomavirus (HPV) DNA are highly sensitive and specific. It is estimated that more than 6 million women in the United States have HPV infection.

Epidemiologic studies convincingly demonstrate that the major risk factor for development of preinvasive or invasive carcinoma of the cervix is HPV infection, which far outweighs other known risk factors such as
high parity,
increasing number of sexual partners,
young age at first intercourse,
low socioeconomic status,
and positive smoking history.

Some patients with HPV infection appear to be at minimal increased risk for development of cervical preinvasive and invasive malignancies while others appear to be at significant risk and candidates for intensive screening programs and/or early intervention.

However, use of a positive HPV DNA test to indictate more in-depth evaluation of the patient may lead to unwarranted and ineffective treatment and/or unnecessary patient anxiety. Conversely, current technology may be too insensitive to detect small amounts of potentially tumorigenic HPV types leading to a false sense of security. Clearly the patient with an abnormal cervical cytology of a high-risk type (Bethesda Classification) should be thoroughly evaluated with colposcopy and biopsy. Patients with low-risk cytology (Bethesda Classification) may or may not have preinvasive or microinvasive cancer and HPV DNA typing may aid in differentiating which patients to evaluate intensively and which to follow more conservatively.

Other studies show patients with low-risk cytology and high-risk HPV infection with types 16, 18, and 31 are more likely to have cervical intraepithelial neoplasia (CIN) or microinvasive histopathology on biopsy. Studies suggest that acute infection with HPV types 16 and 18 conferred an 11- to 16.9-fold risk of rapid development of high-grade CIN.

HPV typing may prove useful, particularly in patients with low-grade cytology or cytology of unclear abnormality.