Outstanding problems – glandular lesions

摘要

Both pre-invasive and invasive cervical glandular lesions remain outstanding challenges. Although the Australian National Cervical Screening Program has led to an accelerated decline in the incidence and mortality from squamous cervical carcinoma, this has not been observed for the subset of women who develop invasive glandular cancers. In addition, the role of cervical cytology, colposcopy and surgery in the management of women with pre-invasive glandular lesions (adenocarcinoma in situ) is far from clearly defined. In this article we have addressed three key questions for the future. Firstly, whether the Australian National Cervical Screening Program is having any impact on the incidence of cervical adenocarcinoma, and if this is the case, can we be more optimistic about the future. Secondly, whether emerging technologies ie. cervical human papillomavirus DNA testing, are likely to play an increasing role in the management of women with pre-invasive glandular lesions. Thirdly, whether there can be any expectation that human papillomavirus vaccination will impact on this disease.