Cervical cancer remains the major cause of death from cancer in women worldwide. While well-established screening programmes and treatment of pre-invasive disease are available in economically developed countries, screening remains opportunistic to non -existent in low-income countries. Cervical cancer and its precursors are caused by persistent infections with high-risk HPV. Early-onset sexual intercourse is an important factor for HPV infection. Excisional treatment for pre-invasive disease is preferred to ablative treatment. A simple hysterectomy is adequate for most microinvasive cancers of the cervix. Virus like particles (VLPs) assembled from recombinant HPV coat proteins are used to constitute HPV vaccine. It has the advantage of being non-infectious, as they contain no viral genetic material. The vaccines prevent HPV-related cancers and ideally are given before sexual debut. Guidelines vary between countries, but vaccination is usually initiated between 9–12 years for both sexes. Preventive HPV vaccination for both sexes remains a cornerstone of preventing HPV related cancers globally.

A 28-year-old female para 0, non-smoker, presents to discuss management of adenocarcinoma in situ (AIS) on colposcopic biopsy. She has been in a mutually monogamous relationship for the past four years, has had two lifetime partners, and uses combined oral contraceptive pills (COCs; ethinyl estradiol 20 mcg/norethindrone 1 mg PO daily) for contraception. She has no past surgical history and no known drug allergies. She had a normal wellness examination three months ago and completed the HPV vaccination series at age 26. Her past medical history is significant for abnormal Pap smear. Her cervical cancer screening history is as follows:

A 39-year-old para 4 cis-woman presents with a history of an office loop electroexcision procedure (LEEP) one year ago. She was told that they “got everything” during her LEEP. At her one-year follow-up appointment, her cervical cytology and human papillomavirus (HPV) testing were abnormal. She reports that a hysterectomy was recommended for recurrent dysplasia. She desires future fertility. She presents for a second opinion as she did not feel heard at her last doctor’s visit. She reports she is otherwise doing well. She is sexually active with male and female partners and uses condoms regularly. Menses are five days long and occur monthly. Her flow is heavy, but this does not bother her. She is a former smoker, with a 10-year pack history, and uses marijuana regularly. She has no other significant past surgical history. She is currently taking cetirizine and is allergic to sulfa antibiotics.