In Armenia more than 1000 women per year are diagnosed as having cervical cancer. However, the number of deaths from cervical cancer has decreased by more than 40% during the last 20 years, and the incidence of cervical cancer is now more than that, for example, breast cancer (41,000 new cases per year). This decrease is directly related to implementation of cervical screening programs. Cervical Pap smears have been used for many years as a screening method for cervical cancer. This test is an important part of the program for preventing this disease in women in Armenia. The goal of cervical cytology screening is to reduce the incidence of cervical cancer by detecting and treating preinvasive lesions. Screening for cervical cancer with the use of cytology has significant effects on the incidence, morbidity, and mortality from invasive disease by facilitating the eradication of precursor lesions. The incidence of preinvasive disease of the cervix has been increasing in Armenia over the past decade. It is estimated that approximately 15% of mild to moderate dysplasias progress to invasive cancer if not treated. Certain predisposing factors of cervical cancer are recognized. Sexual activity seems to be positively correlated with the disease, and sexual intercourse at a relatively early age is a highly significant factor. Cancer of the cervix is 4 times as frequent in women with multiple sexual partners as in other women. The average age at diagnosis of patients with cervical cancer is 45, but the disease can occur even in the second decade of life and occasionally during pregnancy. Over 95% of patients with early cancer of the cervix can be cured. With present methods of management, about 1000 women in the Armenia die of this disease each year. This could be greatly reduced if cervical cancer was detected early and treated properly. By screening Pap smear results a physician plays an important role in lowering death rate from cervical cancer. Only then it is possible to chose an adequate treatment method, if a patient has an abnormal Pap smear result. The choice of financially justified tactics of treating a patient with a low degree of atypia (atypical squamous cells of uncertain significance and squamous cell intra-epithelial disorders of low grade) is of particular importance. The next step - a repeated Pap smear for cytological screening or colposcopy - depends on many circumstances. In this regard, human papilloma viruses (HPV) have got a great deal of attention in recent years. The morphological changes in epithelial cells, which are induced by HPV are frequently seen in cervical intraepithelial neoplasia (CIN). Today, unfortunately, one-half of women who develop cervical cancer have never been screened. Since dysplasia is, probably, a transitional phase in the pathogenesis of many cervical cancers, and many patients with preinvasive disease are asymptomatic, its early detection is extremely important. When dysplasia is diagnosed cytologically, steps should be taken to confirm the diagnosis histologically and to determine the extent of the lesion. In addition to gross inspection of the cervix, the diagnostic procedures include the Schiller test, colposcopic examination, directed biopsy, endocervical curettage. If cervical epithelial neoplasia is combined with signs of an inflammatory process, it is necessary to find the etiological factor and conduct the required treatment. However, an inflammatory process with no infectious agent is often observed in cases of invasive carcinoma of the cervix. It is recommended to have an early repeat examination of the patient. Conclusive diagnosis and management of cervical intraepithelial lesions is based on a combination of consecutive cytology, colposcopy, directed biopsy, and endocervical curettage. In treating CIN the transitional area between the squamous and columnar epithelia, where the abnormalities are located, must be completely removed. Various treatment modalities are possible. The choice of a particular method will depend on the nature of the lesion, the patient's age, and her wishes concerning maintenance of fertility. We are especially in favor of the technique of loop excision. This method allows achieving good results both diagnostically and therapeutically. The procedure is carried out at outpatient clinics under local anesthesia and using colposcopy, the atypical transformation zone is excised with the help of a diathermic loop. It should be pointed out that, irrespective of the treatment chosen, cytological follow-up is indicated in cases of CIN.
