Cervical Cancer Screening in Pregnancy

Abstract

Cervical cancer is the most common genital malignancy diagnosed during pregnancy. Around 3% of newly diagnosed invasive cervical cancer occurs in pregnant women. The prevalence of abnormal cytological test result in pregnancy does not differ from the age-matched non-pregnant population. The present guidelines for cervical cancer screening in the pregnant population are not different from those in the non-pregnant population. The screening guidelines are dependent on the severity of abnormality on cytological test report. Due to hormonal changes in the pregnant cervix, interpretation of cytology and visual screening tests becomes difficult. Expectant management can be done in case of human papillomavirus DNA test positive cases until postpartum. In low-grade abnormalities on Papanicolaou smear, visual inspection on acetic acid (VIA) positive and even human papillomavirus DNA test positive cases colposcopy and/or biopsy may be deferred until 6 weeks postpartum. In case of high-grade lesions, biopsy should be performed to rule out invasive cancers. Treatment options are also the same as in non-pregnant women but shall be reserved for highly selected cases and only to rule out invasive cancers. In invasive cancer cases, appropriate referral to the oncology center with a multidisciplinary team approach can influence the obstetric outcome as well as the prognosis of the disease.