The Washington Manual of Medical Therapeutics helps you diagnose and treat hundreds of medical conditions. Consult clinical recommendations from a resource that has been trusted on the wards for 50+ years. Explore these free sample topics:
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Cervical cancer death rates have declined by almost 80% between 1930 and 2010 because of the widespread implementation of screening programs. In countries that lack a cervical cancer screening and prevention program, cervical cancer is the second most common cancer seen in women. The most important risk factor is persistent HPV infection, detected in >99% of tumors, usually HPV-16 and -18. Other risk factors include early onset of sexual activity, multiple sexual partners, high-risk partner, history of sexually transmitted disease, and chronic immunosuppression (HIV infection).
The prophylactic quadrivalent HPV vaccine protects against types 6, 11, 16, and 18 (Gardasil), whereas the bivalent vaccine protects against HPV-16 and -18. Vaccinated women should continue routine Pap smears because the vaccine is not effective against all HPV subtypes. Cervical cancer screening should begin at age 21, with use of cytology (age 21–29) or cytology plus HPV cotesting (age 30–65) every 3–5 years based on the modality of testing used, per the USPSTF guidelines.