{ "schemaVersion": 2, "eyebrow": "Gynecologic Oncology", "title": "Cervical Cancer", "summary": "Cervical cancer care hinges on prevention through HPV-based screening, prompt risk-based evaluation of abnormal results, stage-appropriate local therapy, and biomarker-directed systemic treatment for persistent, recurrent, or metastatic disease.", "seoDescription": "Physician guide to cervical cancer screening, diagnostic evaluation, treatment principles, recurrent disease systemic therapy, and evidence-based care decisions.", "clinicalQuestion": "How should clinicians integrate cervical cancer prevention, screening, diagnostic evaluation, and treatment selection across localized and recurrent or metastatic disease?", "specialty": "Gynecology and Gynecologic Oncology", "audience": "U.S. physicians and medical trainees", "tags": [ "cervical cancer", "HPV testing", "cervical cancer screening", "PD-L1 CPS", "recurrent cervical cancer", "tisotumab vedotin", "brachytherapy" ], "keyTakeaways": [ "High-risk HPV is a necessary cause of virtually all cervical cancers; screening strategies must balance detection of CIN2+/CIN3+ against avoidable colposcopy and treatment harms. [1][14]", "Primary high-risk HPV testing is generally more sensitive and less specific than cytology alone; combined-test strategies alter this tradeoff according to the decision rule used. [14]", "For PD-L1-positive persistent, recurrent, or metastatic cervical cancer (CPS ≥1), pembrolizumab plus chemotherapy, with or without bevacizumab, improved median overall survival versus chemotherapy-based control in the FDA-reviewed trial. [8]", "Brachytherapy is an essential component of treatment for locally advanced cervical cancer and is associated with lower cervical cancer-specific and all-cause mortality in U.S. observational data. [18]" ], "sections": [ { "id": "clinical-priorities", "eyebrow": "Point of care", "heading": "Clinical priorities across the care continuum", "intro": "Prioritize prevention, timely diagnostic resolution, and multidisciplinary treatment selection.", "paragraphs": [ "Cervical cancer prevention and early detection depend on validated high-risk HPV testing, cytology-based triage when indicated, and reliable completion of colposcopy and treatment pathways. High-risk HPV infection is considered necessary for virtually all cervical cancers; FDA guidance identifies 12 carcinogenic genotypes as core targets for high-risk HPV assays: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59. [1]", "Once invasive cancer is diagnosed, management is stage- and resectability-dependent and should be coordinated with gynecologic oncology and radiation oncology. Available evidence supports surgery or radiation-based treatment for localized disease, while concurrent chemoradiation is used for locally advanced disease; brachytherapy remains a critical component of definitive radiation treatment. [18][24]", "For persistent, recurrent, or metastatic disease, treatment selection is driven by prior therapy, performance status, organ function, disease distribution, and tumor biomarkers—particularly PD-L1 expression for pembrolizumab eligibility in the FDA-approved first-line setting. [8]" ], "bullets": [ "Do not equate an HPV-positive result with cancer; its principal near-term clinical role is risk stratification and triage. [1][14]", "Do not allow a negative HPV result to defer indicated colposcopy in a patient with high-grade cytology. [1]", "For potentially curative locally advanced disease, ensure referral to a center able to deliver brachytherapy. [18]" ], "subsections": [], "table": { "caption": "High-value cervical cancer decisions across the care continuum. [1][8][18]", "columns": [ "Clinical setting", "Decision that changes care", "Evidence-supported action" ], "rows": [ [ "Screening", "Choice of screening test", "High-risk HPV testing is more sensitive but less specific than cytology alone; use a validated programmatic strategy with defined triage. [14]" ], [ "Abnormal screening result", "Need for diagnostic evaluation", "Interpret HPV, cytology, and genotype results in a risk-based pathway; high-grade cytology requires evaluation even with a negative HPV result. [1]" ], [ "Locally advanced disease", "Definitive local modality", "Incorporate brachytherapy into definitive radiation treatment when indicated; omission is associated with worse survival in observational U.S. data. [18]" ], [ "Persistent, recurrent, or metastatic disease", "Systemic treatment eligibility", "Obtain PD-L1 testing with an FDA-approved assay when considering pembrolizumab-containing first-line therapy; FDA indication requires CPS ≥1. [8]" ] ] } }, { "id": "screening-and-triage", "eyebrow": "Prevention and diagnosis", "heading": "Use validated HPV-based screening and risk-based triage", "intro": "Test performance and downstream harms should determine the screening pathway.", "paragraphs": [ "The supplied evidence supports three broad screening modalities: cytology alone, high-risk HPV testing alone, and cotesting. In a network meta-analysis of 27 prospective studies involving 185,269 asymptomatic women, non-HPV16/18 high-risk HPV assays were generally more sensitive and less specific for CIN2+ than standalone cytology. [14]", "Combining cytology and high-risk HPV testing increases or decreases sensitivity and specificity according to the rule used. An either-positive rule maximizes sensitivity at the expense of specificity, whereas requiring both tests to be positive increases specificity but lowers sensitivity. This tradeoff matters because false-positive screening tests lead to additional testing, colposcopy, biopsy, and potential overtreatment. [14]", "FDA device guidance emphasizes that clinical validity is tied to the specific intended use, population, specimen type, collection medium, and assay cutoff. A negative result does not validate an assay outside its approved specimen and clinical-use setting. False-negative results can delay diagnosis, whereas false-positive results can lead to unnecessary colposcopy, biopsy, and potentially fertility-affecting treatment. [1]" ], "bullets": [ "Use only assays and collection systems validated for the intended screening application. [1]", "Treat HPV16/18 genotype information as risk stratification, not as a substitute for the full screening-management pathway. [1][14]", "Recognize that test-performance comparisons from heterogeneous screening studies do not replace current U.S. risk-based management guidance for an individual patient. [14]" ], "subsections": [ { "heading": "Emerging self-collected and urine-based testing", "paragraphs": [ "First-void urine HPV and methylation testing is investigational for routine U.S. cervical screening based on the supplied literature. In a referral-enriched European study, urinary ASCL1/LHX8 methylation had validated CIN3+ sensitivity of 73.0% and specificity of 81.9%; urinary HPV testing was more sensitive but less specific. These data cannot establish a U.S. screening interval or replace approved cervical-sample pathways. [13]" ], "bullets": [ "Do not extrapolate referral-population diagnostic accuracy to average-risk U.S. screening populations. [13]", "Longitudinal screening-cohort validation remains necessary before urine methylation triage can be considered program-ready. [13]" ] } ], "table": { "caption": "Relative test-performance implications for CIN2+ screening in asymptomatic women. [14]", "columns": [ "Strategy", "Sensitivity implication", "Specificity implication", "Clinical consequence" ], "rows": [ [ "High-risk HPV testing alone versus cytology alone", "Generally higher. [14]", "Generally lower. [14]", "Finds more precancer but increases positive results requiring triage. [14]" ], [ "HPV plus cytology, either-positive rule", "Highest among compared combination approaches. [14]", "Lowest among compared combination approaches. [14]", "Minimizes missed disease at cost of more downstream procedures. [14]" ], [ "HPV plus cytology, both-positive rule", "Lower. [14]", "Highest among compared combination approaches. [14]", "Reduces false positives but risks more missed CIN2+. [14]" ] ] } }, { "id": "diagnostic-evaluation", "eyebrow": "After an abnormal test", "heading": "Prevent diagnostic delay after abnormal screening", "intro": "The immediate objective is histologic clarification without avoidable verification bias.", "paragraphs": [ "Colposcopy with biopsy, when indicated, provides the clinical reference standard for assessment of cervical precancer and cancer in HPV device studies. FDA guidance recommends standardized biopsy methods, blinded assessment of investigational HPV results, and pathology reporting that distinguishes CIN2 from CIN3 because CIN3 is more likely to progress to cancer. [1]", "For women with ASC-US cytology undergoing HPV triage, FDA guidance describes prospective evaluation in which all women proceed to colposcopy irrespective of HPV status, with colposcopy performed within 12 weeks of the screening specimen. This design avoids verification bias in test assessment; in practice, management should follow current risk-based U.S. guidance rather than the device-study protocol alone. [1]", "A negative HPV result should not prevent colposcopy when cytology is more severe than ASC-US. FDA specifically notes that, in women aged 30 years or older with greater than ASC-US cytology, a negative HPV result should not prevent referral to colposcopy. [1]" ], "bullets": [ "Document cytology category using Bethesda terminology and obtain histology when colposcopy is indicated. [1]", "When pathology uses two-tier LAST terminology, retain clinically meaningful distinction between lower-grade and high-grade lesions and clarify whether terminology refers to cytology or histology. [1]", "Escalate promptly for suspected invasive disease; the supplied sources do not provide a complete staging-workup algorithm." ], "subsections": [], "table": { "caption": "Diagnostic-process safeguards supported by FDA HPV device guidance. [1]", "columns": [ "Potential failure", "Why it matters", "Safeguard" ], "rows": [ [ "HPV-directed verification only", "Can overestimate sensitivity by verification bias. [1]", "Use risk-appropriate colposcopy and histology evaluation independent of investigational HPV status in clinical studies. [1]" ], [ "Delayed colposcopy after ASC-US study enrollment", "Lesion regression can distort performance estimates. [1]", "FDA device-study guidance specifies completion within 12 weeks. [1]" ], [ "Negative HPV with high-grade cytology", "May falsely reassure despite a high-risk cytologic signal. [1]", "Proceed with indicated colposcopy; HPV negativity should not block referral for >ASC-US cytology. [1]" ] ] } }, { "id": "localized-disease", "eyebrow": "Definitive treatment", "heading": "Preserve curative options in localized and locally advanced disease", "intro": "Treatment planning requires gynecologic oncology and radiation oncology coordination.", "paragraphs": [ "The supplied sources support surgery and radiation as principal modalities for localized cervical cancer, with concurrent chemoradiation described as the treatment of choice for locally advanced tumors. [24] Selection between surgery and radiation depends on disease extent, anticipated need for adjuvant treatment, patient comorbidity, and fertility implications; detailed stage-specific operative criteria are not available in the supplied sources.", "For stage IB2–IVA cervical cancer, brachytherapy utilization is independently associated with lower cervical cancer-specific mortality and all-cause mortality in U.S. observational analyses. The source characterizes brachytherapy as an essential component of treatment for locally advanced cervical cancer. [18]", "The practical implication is referral early enough to avoid substituting external-beam dose escalation for an indicated brachytherapy boost. MRI-guided brachytherapy has been associated with an approximately 10% overall-survival benefit compared with historical cohorts in the evidence summarized by the SEER analysis, but that estimate is not from a randomized comparison. [18]" ], "bullets": [ "Refer patients with locally advanced disease to radiation programs that can deliver intracavitary or hybrid intracavitary-interstitial brachytherapy. [18]", "Avoid treatment sequencing that produces prolonged delays in definitive radiation or brachytherapy; the supplied sources do not provide an exact acceptable overall treatment-time threshold.", "Discuss fertility, ovarian function, sexual health, bowel and bladder toxicity, and survivorship needs before treatment planning; detailed rates are not available in the supplied sources." ], "subsections": [], "table": { "caption": "Local-treatment principles supported by supplied evidence. [18][24]", "columns": [ "Disease context", "Core treatment principle", "Decision risk if omitted" ], "rows": [ [ "Localized disease", "Use surgery or radiation-based local therapy as appropriate to disease extent and patient factors. [24]", "Inappropriate modality selection may compromise cure or expose the patient to combined-modality morbidity. [24]" ], [ "Locally advanced disease", "Use primary concurrent chemoradiation, incorporating brachytherapy. [18][24]", "Omission of brachytherapy is associated with inferior survival in observational data. [18]" ] ] } }, { "id": "recurrent-metastatic", "eyebrow": "Systemic therapy", "heading": "Select systemic therapy by biomarker and prior treatment exposure", "intro": "PD-L1 status is actionable in first-line persistent, recurrent, or metastatic disease.", "paragraphs": [ "For persistent, recurrent, or metastatic cervical cancer with tumor PD-L1 CPS of at least 1, the FDA approved pembrolizumab in combination with chemotherapy, with or without bevacizumab, as first-line treatment. In the FDA-reviewed trial population with CPS at least 1, median overall survival was not reached with pembrolizumab-based therapy versus 16.3 months with placebo-based therapy (hazard ratio 0.64); median progression-free survival was 10.4 versus 8.2 months (hazard ratio 0.62). [8]", "Tisotumab vedotin-tftv received FDA accelerated approval for adults with recurrent or metastatic cervical cancer progressing on or after chemotherapy. In a single-arm study of 101 patients treated with 2 mg/kg intravenously every 3 weeks, confirmed objective response rate was 24% and median response duration was 8.3 months. Labeling included a boxed warning for ocular toxicity. [3]", "Topotecan plus cisplatin remains FDA-labeled for stage IVB, recurrent, or persistent cervical carcinoma not amenable to curative surgery or radiation. The labeled regimen is topotecan 0.75 mg/m² IV over 30 minutes on days 1–3 plus cisplatin 50 mg/m² IV on day 1 every 21 days. In the cited comparative trial, median survival was 9.4 months with the combination versus 6.5 months with cisplatin alone. [4]" ], "bullets": [ "Order PD-L1 testing with an FDA-approved test before selecting pembrolizumab-containing first-line treatment; the FDA indication specifies CPS ≥1. [8]", "For tisotumab vedotin, arrange baseline and ongoing ophthalmic monitoring consistent with current product labeling; the supplied FDA summary identifies ocular toxicity as a boxed warning but does not provide the monitoring protocol. [3]", "For topotecan-cisplatin, confirm baseline marrow reserve and renal eligibility. Topotecan labeling requires baseline neutrophils greater than 1,500/mm³ and platelets greater than 100,000/mm³; cervical-cancer combination treatment should be initiated only when serum creatinine is 1.5 mg/dL or less. [4]" ], "subsections": [ { "heading": "Toxicity tradeoffs that affect regimen selection", "paragraphs": [ "Topotecan-cisplatin has substantial hematologic toxicity. In the cervical-cancer comparative trial, all-grade anemia, leukopenia, neutropenia, and thrombocytopenia occurred in 94%, 91%, 89%, and 74% of patients receiving the combination, respectively; grade 4 neutropenia occurred in 48%. [4]", "Tisotumab vedotin adverse effects commonly included decreased hemoglobin, fatigue, nausea, peripheral neuropathy, hemorrhage, conjunctival adverse reactions, dry eye, and laboratory cytopenias. [3] These risks should be weighed against prior toxicity, tumor-related bleeding risk, neuropathy, and capacity for ophthalmic surveillance." ], "bullets": [ "Do not administer topotecan with baseline neutrophils below 1,500/mm³. [4]", "Monitor peripheral blood counts frequently during topotecan therapy; defer subsequent courses until neutrophils exceed 1,000/mm³, platelets exceed 100,000/mm³, and hemoglobin is 9 g/dL or greater, with transfusion if needed. [4]", "Consider neutropenic colitis in a patient receiving topotecan who develops fever, neutropenia, and abdominal pain. [4]" ] } ], "table": { "caption": "Selected FDA-supported systemic options for persistent, recurrent, or metastatic cervical cancer. [3][4][8]", "columns": [ "Therapy", "Eligible population in supplied source", "Dose or regimen", "Key efficacy finding", "Major selection issue" ], "rows": [ [ "Pembrolizumab plus chemotherapy with or without bevacizumab", "Persistent, recurrent, or metastatic disease with PD-L1 CPS ≥1. [8]", "Pembrolizumab 200 mg plus chemotherapy with or without bevacizumab in the FDA-reviewed trial; continued until progression, unacceptable toxicity, or 24 months. [8]", "Median OS not reached versus 16.3 months; HR 0.64. [8]", "Requires PD-L1 CPS ≥1 by FDA-approved test. [8]" ], [ "Tisotumab vedotin-tftv", "Recurrent or metastatic disease progressing on or after chemotherapy. [3]", "2 mg/kg IV every 3 weeks; maximum 200 mg for patients weighing at least 100 kg. [3]", "ORR 24%; median response duration 8.3 months. [3]", "Boxed warning for ocular toxicity. [3]" ], [ "Topotecan plus cisplatin", "Stage IVB, recurrent, or persistent disease not amenable to curative surgery or radiation. [4]", "Topotecan 0.75 mg/m² IV days 1–3 plus cisplatin 50 mg/m² IV day 1, every 21 days. [4]", "Median survival 9.4 versus 6.5 months with cisplatin alone. [4]", "High myelosuppression burden and renal constraints. [4]" ] ] } }, { "id": "evidence-gaps", "eyebrow": "Interpretation", "heading": "Apply emerging evidence cautiously", "intro": "Not all technically promising tests or prediction tools are ready for clinical adoption.", "paragraphs": [ "Urine-based HPV and methylation strategies are promising, especially for reaching underscreened populations, but the cited clinical study was performed in European referral and control cohorts rather than a U.S. population screening program. It explicitly identifies the need for longitudinal validation to define safe screening intervals. [13]", "Machine-learning studies using small public datasets should not guide clinical diagnosis or replace validated screening and diagnostic pathways. One cited model achieved near-perfect performance using a dataset of 858 records, but the model incorporated Schiller, Hinselmann, cytology, and biopsy-related testing variables; these are not independent pre-screening risk factors and create a high risk of circular prediction rather than clinically transportable diagnostic performance. [15]", "For screening and triage, use patient-important outcomes—not only cross-sectional test accuracy—to assess benefit. The network meta-analysis concludes that comparative strategies need evaluation at the program level, including false-positive procedures, false negatives, long-term outcomes, resources, and costs. [14]" ], "bullets": [ "Do not use AI risk scores as a replacement for HPV testing, cytology, colposcopy, histology, or formal staging. [15]", "Do not adopt urine methylation triage as routine U.S. care solely on referral-cohort performance. [13]", "When interpreting screening evidence, distinguish detection of CIN2+ from prevention of invasive cancer and from treatment benefit. [14]" ], "subsections": [], "table": { "caption": "Evidence limitations relevant to current U.S. practice. [13][14][15]", "columns": [ "Evidence type", "Potential value", "Why it should not yet change routine care" ], "rows": [ [ "First-void urine methylation study", "May enable molecular triage from a home-collected sample. [13]", "Referral-enriched cohort and lack of longitudinal screening validation limit generalizability. [13]" ], [ "Screening network meta-analysis", "Quantifies sensitivity-specificity tradeoffs among HPV and cytology strategies. [14]", "Heterogeneity and cross-sectional accuracy do not establish a single optimal program for every population. [14]" ], [ "Machine-learning risk model", "Illustrates prediction-method development. [15]", "Use of diagnostic test variables and a small public dataset limits clinical transportability. [15]" ] ] } } ], "faq": [ { "question": "What is the most actionable biomarker in recurrent or metastatic cervical cancer?", "answer": "PD-L1 expression is directly actionable for pembrolizumab plus chemotherapy, with or without bevacizumab, in persistent, recurrent, or metastatic disease when CPS is at least 1 by an FDA-approved test. [8]" }, { "question": "Can a negative HPV result exclude the need for colposcopy in high-grade cytology?", "answer": "No. FDA HPV-device guidance states that a negative HPV result in women aged 30 years or older with greater than ASC-US cytology should not prevent colposcopy. [1]" }, { "question": "Why is brachytherapy important in locally advanced cervical cancer?", "answer": "Brachytherapy is described as an essential component of locally advanced cervical cancer treatment and is associated with lower cervical cancer-specific and all-cause mortality in U.S. observational data. [18]" }, { "question": "Is urine-based cervical cancer screening ready for routine U.S. use?", "answer": "Not based on the supplied evidence. First-void urine HPV and methylation testing is promising, but validation in longitudinal screening populations is still needed before defining routine screening intervals or management pathways. [13]" } ], "references": [ { "number": 1, "title": "Establishing the Performance Characteristics of In Vitro ...", "detail": "www.fda.gov", "url": "https://www.fda.gov/media/92930/download", "authors": "www.fda.gov", "host": "www.fda.gov" }, { "number": 2, "title": "highlights of prescribing information", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=9c6fc66b-522f-499d-961a-cde6ca0ec2e5&type=display", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov" }, { "number": 3, "title": "FDA grants accelerated approval to tisotumab vedotin-tftv for recurrent or metastatic cervical cancer | FDA", "detail": "www.fda.gov", "url": "https://www.fda.gov/drugs/resources-information-approved-drugs/fda-grants-accelerated-approval-tisotumab-vedotin-tftv-recurrent-or-metastatic-cervical-cancer", "authors": "www.fda.gov", "host": "www.fda.gov" }, { "number": 4, "title": "These highlights do not include all the information needed to use TOPOTECAN INJECTION safely and effectively.\n \n \nSee full prescribing information for TOPOTECAN INJECTION.\n \n \n \n \nTOPOTECAN Injection\n \n \nMust be diluted before intravenous infusion\n \n \nInitial U.S. Approval: 1996", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=7636bc1e-77b6-46ad-9df0-c8bb1c5e503f&type=display", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov" }, { "number": 5, "title": "ZETIA", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/downloadpdffile.cfm?setId=", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov" }, { "number": 6, "title": "See full prescribing information for complete boxed warning.", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=9c75e30a-a410-40f1-b653-04d532bd9144", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov" }, { "number": 7, "title": "OCE Conversations on Cancer, Cervical Cancer Treatment Innovation: A Collaborative Discussion - 01/14/2025 | FDA", "detail": "www.fda.gov", "url": "https://www.fda.gov/news-events/fda-meetings-conferences-and-workshops/oce-conversations-cancer-cervical-cancer-treatment-innovation-collaborative-discussion-01142025", "authors": "www.fda.gov", "host": "www.fda.gov" }, { "number": 8, "title": "FDA approves pembrolizumab combination for the first-line treatment of cervical cancer | FDA", "detail": "www.fda.gov", "url": "http://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-pembrolizumab-combination-first-line-treatment-cervical-cancer", "authors": "www.fda.gov", "host": "www.fda.gov" }, { "number": 9, "title": "First Drug Treatment for Late-Stage Cervical Cancer Approved | NEJM Clinician", "detail": "clinician.nejm.org", "url": "https://clinician.nejm.org/first-drug-treatment-late-stage-cervical-cancer-approved-FW200606160000003", "authors": "clinician.nejm.org", "host": "clinician.nejm.org" }, { "number": 10, "title": "Screening for Cervical Cancer", "detail": "www.acpjournals.org", "url": "https://www.acpjournals.org/doi/pdf/10.7326/0003-4819-156-12-201206190-00424", "authors": "www.acpjournals.org", "host": "www.acpjournals.org" }, { "number": 11, "title": "Screening for Cervical Cancer: U.S. Preventive Services ...", "detail": "www.acpjournals.org", "url": "https://www.acpjournals.org/doi/10.7326/0003-4819-156-12-201206190-00424", "authors": "www.acpjournals.org", "host": "www.acpjournals.org" }, { "number": 12, "title": "The effect of marital status on cervical cancer related prognosis: a propensity score matching study | Scientific Reports", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-025-19122-3", "authors": "www.nature.com", "host": "www.nature.com" }, { "number": 13, "title": "Clinical performance of ASCL1/LHX8 DNA methylation on first-void urine to screen for cervical cancer | Communications Medicine", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s43856-026-01512-x", "authors": "www.nature.com", "host": "www.nature.com" }, { "number": 14, "title": "Comparative accuracy of cervical cancer screening strategies in healthy asymptomatic women: a systematic review and network meta-analysis | Scientific Reports", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-021-04201-y", "authors": "www.nature.com", "host": "www.nature.com" }, { "number": 15, "title": "Enhanced cervical cancer diagnosis using a novel Bayesian fusion ensemble method with explainable AI | Scientific Reports", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-026-35334-7", "authors": "www.nature.com", "host": "www.nature.com" }, { "number": 16, "title": "WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention", "detail": "go.nature.com", "url": "https://go.nature.com/3LFNOSK", "authors": "go.nature.com", "host": "go.nature.com" }, { "number": 17, "title": "Practice Bulletin No. 157 : Obstetrics & Gynecology", "detail": "journals.lww.com", "url": "https://journals.lww.com/greenjournal/fulltext/10.1097/aog.0000000000001263~practice-bulletin-no-157-cervical-cancer-screening-and", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 18, "title": "Updated Trends in the Utilization of Brachytherapy in Cervical Cancer in the United States: A Surveillance, Epidemiology, and End-Results Study - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0360301623081324", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 19, "title": "S3519 A Rare Case of Epigastric Pain Caused by... : American Journal of Gastroenterology", "detail": "journals.lww.com", "url": "https://journals.lww.com/ajg/fulltext/10.14309/01.ajg.0000870716.42865.14~s3519a-rare-case-of-epigastric-pain-caused-by-duodenal", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 20, "title": "Human Papillomavirus DNA Testing for Cervical Cancer ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/jnci/article/92/10/818/2905767", "authors": "academic.oup.com", "host": "academic.oup.com" }, { "number": 21, "title": "Guidelines for the Treatment of Recurrent and Metastatic ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/oncolo/article-abstract/7/4/342/6386720", "authors": "academic.oup.com", "host": "academic.oup.com" }, { "number": 22, "title": "AACC Guidance Document on Cervical Cancer Detection", "detail": "academic.oup.com", "url": "https://academic.oup.com/jalm/article-abstract/8/2/382/7030135", "authors": "academic.oup.com", "host": "academic.oup.com" }, { "number": 23, "title": "Cervical cancer: ESMO Clinical Practice Guidelines for ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/annonc/article/28/suppl_4/iv72/3958154", "authors": "academic.oup.com", "host": "academic.oup.com" }, { "number": 24, "title": "Current treatment options and limitations for cervical cancer - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/B9780443289859000057", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" } ], "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Establishing the Performance Characteristics of In Vitro ...", "detail": "www.fda.gov", "url": "https://www.fda.gov/media/92930/download", "authors": "www.fda.gov", "host": "www.fda.gov", "snippet": "is highly sensitive not only for cervical pre-cancer, such as CIN2 and CIN3, but for cervical cancer itself. Therefore, additional testing with the investigational device should be conducted on cytology samples collected from females who have subsequently been diagnosed with cervical cancer, using b", "score": 0.14411299 }, { "number": 2, "title": "highlights of prescribing information", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=9c6fc66b-522f-499d-961a-cde6ca0ec2e5&type=display", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov", "snippet": "## 2.3 Dosage Modifications in Renal and Hepatic Impairment\n\nRenal Impairment\n \nUse the lowest recommended starting dosage for MERCAPTOPURINE or increase the dosing interval to every 36 to 48 hours in patients with renal impairment (CLcr less than 50 mL/min). Adjust the dosage to maintain absolute ", "score": 0.55883324 }, { "number": 3, "title": "FDA grants accelerated approval to tisotumab vedotin-tftv for recurrent or metastatic cervical cancer | FDA", "detail": "www.fda.gov", "url": "https://www.fda.gov/drugs/resources-information-approved-drugs/fda-grants-accelerated-approval-tisotumab-vedotin-tftv-recurrent-or-metastatic-cervical-cancer", "authors": "www.fda.gov", "host": "www.fda.gov", "snippet": "The recommended dose is 2 mg/kg (up to a maximum of 200 mg for patients ≥100 kg) given as an intravenous infusion over 30 minutes every 3 weeks until disease progression or unacceptable toxicity.\n\nView full prescribing information for Tivdak.\n\nThis review used the Assessment Aid, a voluntary submiss", "score": 0.54985875 }, { "number": 4, "title": "These highlights do not include all the information needed to use TOPOTECAN INJECTION safely and effectively.\n \n \nSee full prescribing information for TOPOTECAN INJECTION.\n \n \n \n \nTOPOTECAN Injection\n \n \nMust be diluted before intravenous infusion\n \n \nInitial U.S. Approval: 1996", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=7636bc1e-77b6-46ad-9df0-c8bb1c5e503f&type=display", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov", "snippet": "| | FULL PRESCRIBING INFORMATION: CONTENTS\\WARNING: BONE MARROW SUPPRESSION1 INDICATIONS AND USAGE2 DOSAGE AND ADMINISTRATION2.1 Small Cell Lung Cancer2.2 Cervical Cancer2.3 Dosage Adjustment in Specific Populations2.4 Instructions for Handling, Preparation and Intravenous A", "score": 0.41094592 }, { "number": 5, "title": "ZETIA", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/downloadpdffile.cfm?setId=", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov", "snippet": "No dosage adjustment is necessary in patients with mild hepatic impairment ... No dosage adjustment is necessary in patients with renal impairment [see Clinical.", "score": 0.32733542 }, { "number": 6, "title": "See full prescribing information for complete boxed warning.", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=9c75e30a-a410-40f1-b653-04d532bd9144", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov", "snippet": "No dosage adjustment is recommended in patients with mild hepatic impairment. MAVENCLAD is not recommended in patients with moderate to", "score": 0.28706825 }, { "number": 7, "title": "OCE Conversations on Cancer, Cervical Cancer Treatment Innovation: A Collaborative Discussion - 01/14/2025 | FDA", "detail": "www.fda.gov", "url": "https://www.fda.gov/news-events/fda-meetings-conferences-and-workshops/oce-conversations-cancer-cervical-cancer-treatment-innovation-collaborative-discussion-01142025", "authors": "www.fda.gov", "host": "www.fda.gov", "snippet": "Even though cervical cancer is the fourth most common cancer in women globally and is the most common cancer related cause of death in some regions, historically there was minimal drug development for metastatic and recurrent disease. In the US and Europe, while the earliest approvals to treat cervi", "score": 0.18255699 }, { "number": 8, "title": "FDA approves pembrolizumab combination for the first-line treatment of cervical cancer | FDA", "detail": "www.fda.gov", "url": "http://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-pembrolizumab-combination-first-line-treatment-cervical-cancer", "authors": "www.fda.gov", "host": "www.fda.gov", "snippet": "Title: FDA approves pembrolizumab combination for the first-line treatment of cervical cancer | FDA\n# FDA approves pembrolizumab combination for the first-line treatment of cervical cancer. On October 13,2021, the Food and Drug Administration approved pembrolizumab (Keytruda, Merck) in combination w", "score": 0.16918644 }, { "number": 9, "title": "First Drug Treatment for Late-Stage Cervical Cancer Approved | NEJM Clinician", "detail": "clinician.nejm.org", "url": "https://clinician.nejm.org/first-drug-treatment-late-stage-cervical-cancer-approved-FW200606160000003", "authors": "clinician.nejm.org", "host": "clinician.nejm.org", "snippet": "Copyright © 2026\n\nMassachusetts Medical Society.\n\nAll rights reserved, including those for text and data mining, AI training, and similar technologies.\n\nElectronic ISSN 3067-1876\n\nThe content of this site is intended for health care professionals.\n\n# First Drug Treatment for Late-Stage Cervical Canc", "score": 0.2583896 }, { "number": 10, "title": "Screening for Cervical Cancer", "detail": "www.acpjournals.org", "url": "https://www.acpjournals.org/doi/pdf/10.7326/0003-4819-156-12-201206190-00424", "authors": "www.acpjournals.org", "host": "www.acpjournals.org", "snippet": "by VA Moyer · 2012 · Cited by 1423 — Pap ⫽ Papanicolaou. Clinical Guideline Screening for Cervical Cancer ... cervical cancer in the United States, 2003-2005. Ann Intern Med", "score": 0.6773251 }, { "number": 11, "title": "Screening for Cervical Cancer: U.S. Preventive Services ...", "detail": "www.acpjournals.org", "url": "https://www.acpjournals.org/doi/10.7326/0003-4819-156-12-201206190-00424", "authors": "www.acpjournals.org", "host": "www.acpjournals.org", "snippet": "by VA Moyer · 2012 · Cited by 1423 — An estimated 12 200 new cases of cervical cancer and 4210 deaths occurred in the United States in 2010 (1). Cervical cancer deaths in the United", "score": 0.25947174 }, { "number": 12, "title": "The effect of marital status on cervical cancer related prognosis: a propensity score matching study | Scientific Reports", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-025-19122-3", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "Current studies have shown that the prognosis of cervical cancer is related to a variety of factors, mainly the histopathological features of the tumor, such as the size of the primary tumor, lymph node metastasis, lymphatic-vascular space infiltration, staging, and histological grade4.\"),5.\"),6.\"),", "score": 0.43943515 }, { "number": 13, "title": "Clinical performance of ASCL1/LHX8 DNA methylation on first-void urine to screen for cervical cancer | Communications Medicine", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s43856-026-01512-x", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "of the threshold. To ensure a similar distribution across underlying disease groups, random assignment to training and validation cohorts was stratified by disease group (< CIN2, CIN2, CIN3, and cancer). The model assessed how well it could detect CIN3 lesions or worse (sensitivity for CIN3 + ), whi", "score": 0.4387136 }, { "number": 14, "title": "Comparative accuracy of cervical cancer screening strategies in healthy asymptomatic women: a systematic review and network meta-analysis | Scientific Reports", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-021-04201-y", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "We operationally categorized combination tests as follows: (i) combination algorithms based on the OR rule (women with either test positive were categorized as screening positive while women with both tests negative as screening negative) or the AND rule (women with both tests positive were categori", "score": 0.418341 }, { "number": 15, "title": "Enhanced cervical cancer diagnosis using a novel Bayesian fusion ensemble method with explainable AI | Scientific Reports", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-026-35334-7", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "Article \n Google Scholar\n21. Gopinath, B. & Santhi, R. & Dhivya Praba, R. A machine learning based decision support system to predict the presence of cervical cancer. in 2nd International Conference on Advancements in Electrical, Electronics, Communication, Computing and Automation (ICAECA) (IEEE", "score": 0.31725752 }, { "number": 16, "title": "WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention", "detail": "go.nature.com", "url": "https://go.nature.com/3LFNOSK", "authors": "go.nature.com", "host": "go.nature.com", "snippet": "Funding\n + Investment in WHO\n + WHO Foundation\n\n Accountability\n + External audit\n + Financial statements\n + Internal audit and investigations\n + Programme Budget\n + Results reports\n\n Governance\n + Governing bodies\n + World Health Assembly\n + Executive Board\n + Member States Portal\n\n# WHO", "score": 0.528899 }, { "number": 17, "title": "Practice Bulletin No. 157 : Obstetrics & Gynecology", "detail": "journals.lww.com", "url": "https://journals.lww.com/greenjournal/fulltext/10.1097/aog.0000000000001263~practice-bulletin-no-157-cervical-cancer-screening-and", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "in 2014 by the U.S. Food and Drug Administration (FDA) (8). The purpose of this document is to provide a review of the best available evidence regarding the prevention and early detection of cervical cancer. [...] New technologies for cervical cancer screening continue to evolve, as do recommendatio", "score": 0.47504577 }, { "number": 18, "title": "Updated Trends in the Utilization of Brachytherapy in Cervical Cancer in the United States: A Surveillance, Epidemiology, and End-Results Study - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0360301623081324", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "# CLINICAL INVESTIGATION Updated Trends in the Utilization of Brachytherapy in Cervical Cancer in the United States: A Surveillance, Epidemiology, and End-Results Study. This study evaluates recent trends in brachytherapy utilization in cervical cancer and identifies factors and survival benefit ass", "score": 0.40500212 }, { "number": 19, "title": "S3519 A Rare Case of Epigastric Pain Caused by... : American Journal of Gastroenterology", "detail": "journals.lww.com", "url": "https://journals.lww.com/ajg/fulltext/10.14309/01.ajg.0000870716.42865.14~s3519a-rare-case-of-epigastric-pain-caused-by-duodenal", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Advertisement\n\nImage 1: Journals\n\nACG Journals\n\nACG Journals\n\nSearch Search\n\nSearch History\n\nLog in\n\nNavbar\n\nMenu\n\n Articles & Issues \n For Authors \n Journal Info \n ACG Clinical Guidelines \n Collections \n\n More menu items \n\nSearch\n\nHistory\n\nButton group.\n\n Check Access \n ", "score": 0.21236303 }, { "number": 20, "title": "Human Papillomavirus DNA Testing for Cervical Cancer ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/jnci/article/92/10/818/2905767", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by L Kuhn · 2000 · Cited by 367 — This study was designed to evaluate HPV DNA testing as a primary cervical cancer screening method for low-resource settings.", "score": 0.1682824 }, { "number": 21, "title": "Guidelines for the Treatment of Recurrent and Metastatic ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/oncolo/article-abstract/7/4/342/6386720", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by M Friedlander · 2002 · Cited by 337 — This paper reviews the approach to management of patients who relapse after primary treatment for cervical cancer.", "score": 0.5081298 }, { "number": 22, "title": "AACC Guidance Document on Cervical Cancer Detection", "detail": "academic.oup.com", "url": "https://academic.oup.com/jalm/article-abstract/8/2/382/7030135", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by Y Zhu · 2023 · Cited by 9 — This guidance document addresses key questions related to cervical cancer screening and management including currently available cervical cancer", "score": 0.507544 }, { "number": 23, "title": "Cervical cancer: ESMO Clinical Practice Guidelines for ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/annonc/article/28/suppl_4/iv72/3958154", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "Paclitaxel and cisplatin combined with bevacizumab is considered the preferred first-line regimen in metastatic or recurrent cervical cancer", "score": 0.49436116 }, { "number": 24, "title": "Current treatment options and limitations for cervical cancer - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/B9780443289859000057", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Title: Current treatment options and limitations for cervical cancer - ScienceDirect\n## Strategies for Overcoming Chemotherapy Resistance in Cervical Cancer. Strategies for Overcoming Chemotherapy Resistance in Cervical Cancer. # Chapter 2- Current treatment options and limitations for cervical canc", "score": 0.21755393 } ], "publishedAt": "2026-08-21T00:08:29.513487Z", "updatedAt": "2026-08-21T00:08:29.513487Z", "readingMinutes": 8, "slug": "cervical-cancer" }