Whitney, a 34-year-old woman who postponed pregnancy in her 20s has now been trying to get pregnant for several years. Her husband had a son during a prior marriage. She consults her gynaecologist for work-up of her infertility. Relevant history includes menarche at age 13; five lifetime sex partners; cyclic menses regularly every 30 days; no birth control for 2 years; no pelvic examination in 5 years. She reports no smoking and no intravenous drug abuse.
The attending gynaecologist recommends a cervical screening workup, which returns a cervical smear diagnosis of high-grade squamous intraepithelial lesion, and a human papillomavirus (HPV) assay positive for HPV serotype 16. Colposcopy reveals a friable, vascular lesion on the anterior uterine cervix, a biopsy is taken which shows severe dysplasia (CIN III).
Please answer the following TWO questions:
1. Describe pathophysiology of cervical cancer. What risk factors can you identify in Whitney’s case?
(150 words approx.)
2. Why has cervical screening changed from two to five years in Australia? Provide scientific rationale for the new guidelines.
(250 words approx.)