Intraepithelial neoplasia of the lower genital tract (cervix, vagina, vulva)

Cervical cancer is one of the leading causes of cancer and cancer-related deaths among women worldwide, with an estimated 570,000 new cases and 311,000 deaths annually. In May 2018, the director-general of the World Health Organization (WHO) announced a global call to action toward the elimination of cervical cancer (WHO, 2018). The focus of this initiative is on low- and middle-income countries (LMICs), where more than 85% of cervical cancer cases and deaths occur primarily because of a lack of organized screening programs (Bray, 2018). Cervical cancer was previously the leading cause of cancer-related death among women in the United States; however, the incidence and mortality has decreased by approximately 70% over the past 40 years. This decline largely is due to the introduction in 1941 of the Papanicolaou (Pap) smear, which led to a systemic effort to detect early cervical cancer and precancerous lesions (Papanicolaou, 1941); however, cervical cancer continues to be the first or second leading cause of cancer and cancer-related death among women in LMICs and many underserved parts of the United States because of the lack of organized screening and early detection programs. Cervical cancer is a preventable disease, with excellent tools for prevention (vaccination) and screening (Pap and human papillomavirus testing). Furthermore, there is a treatable preinvasive phase that lasts several years before progressing to invasive cancer.