Physician’s notes A 41-year-old female patient with regular menstruation reported increased leucorrhea and vaginal bleeding in January and came to the hospital. The patient was questioned in detail and told that she had attended her annual check-ups regularly and no abnormalities were found. In October last year, she went to the hospital for a checkup because she felt an increase in leucorrhea. At that time, the physician told her that there was “erosion” on the lower lip of the cervix, which was a bit brittle and bled when she touched it, and instructed her to check it carefully again. She thought she had just been examined in June and there was no problem. Then she got busy with work and put it down. This year, after the Spring Festival, the leucorrhea increased, and there was an odor, and bleeding after intercourse, she felt something was wrong, and went to the hospital for another examination. This time, the doctor found that the lower lip of the cervix had 2-3 cm protrusion in the shape of cauliflower, with brittle tissue and easy bleeding, and the lower part had invaded the posterior vaginal fornix. It was highly suspicious for cervical cancer. After colposcopy and pathological examination of local tissue from the cervix, it was confirmed to be cervical cancer and also tested positive for high-risk human papillomavirus (HPV). The patient was immediately admitted to the hospital for surgical treatment. Cervical cancer is the most serious disease threatening women’s health worldwide. With 4,932.43 million incidences and 2,730.05 million deaths worldwide in 2002, it is the third most common tumor in women worldwide, and 78% occur in developing countries, making it the second most prevalent malignancy in women after breast cancer. In China, cervical cancer is also on the rise, despite the lack of detailed national statistics. About 135,000 cases occur each year in China. The age of onset of cervical cancer is most common between 40-55 years old and less common before 20 years old. Squamous carcinoma is the most common, followed by adenocarcinoma and squamous carcinoma. The number of deaths is about 50,000 per year, and according to the WHO, the number of deaths due to cervical cancer will increase by about 25% in the next 10 years if no action is taken soon. Studies over the past 20 years have found that the development of cervical cancer is associated with high-risk human papillomavirus (HPV) infection. German medical scientist zur Hausen was also awarded the 2008 Nobel Prize in Physiology and Medicine for this work. HPV infections in the reproductive tract are common in women, with 70 to 80 percent of women having been infected with HPV at some point in their lives. HPV infection rates are highest in young, sexually active women, with the peak age of infection being 18 to 28 years. However, most women under 30 years of age have a transient infection, and most can eliminate HPV through autoimmunity within about 9 to 16 months of infection. Only women with persistent high-risk HPV infection become a high risk group for cervical cancer. After HPV infection, about 30% to 50% of women develop mild cervical epithelial lesions, and most of them turn normal after infection. It takes 9 to 25 years for HPV infection to develop into cervical cancer, with a long latent period. Therefore, high-risk HPV testing has become a very meaningful indicator in cervical cancer screening. It was found that the incidence of CIN3 was 20% in 10 years if two consecutive HPV positives were detected at an interval of 6 months; if two consecutive HPV negatives were detected, the incidence of CIN3 was only 2.3% in 10 years and 0.5% in 5 years. Danish scholars found that 17.7% of young women and 24.5% of older women with normal cytology and positive HPV had abnormal cytology over the next 5 years; 13.6% of young women and 21.2% of older women were at risk for CIN3 and cervical cancer over the next 10 years. The risk of HPV positivity in young women in the first 2 years, followed by a risk of CIN3 or more in the next 10 years was 18%, increasing to 20% risk in older women. Therefore it is believed that by testing for HPV, it is possible to predict the high risk of precancerous cervical lesions. The prevalence of HPV infection in China is about 14% to 28%. Precancerous lesions and early cancers are usually asymptomatic and are mostly detected during screening. Secondly, vaginal bleeding: initially, it manifests as a small amount of bloody leucorrhea or a small amount of bleeding after sexual intercourse or gynecological examination, called contact bleeding. There may also be a small amount of irregular bleeding during intermenstrual period or after menopause. Increased leukorrhea is also a common symptom. Initially, the amount is not large, white or yellowish, without odor. As the cancerous tissue breaks down and secondary infection occurs, the vagina may discharge a large amount of rice-soup-like, purulent or pus-blood fluid, often accompanied by a foul smell like protein decay. Beijing University People’s Hospital concluded that 78.0% of patients with pathologically confirmed severe precancerous lesions (CIN3) had clinical symptoms of different degrees. Among them, 78.0% had excessive leucorrhea with odor, 49.2% had contact bleeding (i.e. bleeding during intercourse), 39.4% had pubic itching, 74.2% had more than two symptoms at the same time, and 65.9% had moderate to severe “erosion” of the cervix. Therefore, it is important to go to the hospital even if you have these symptoms. In developing countries, it is estimated that 95% of women have not been screened for cervical cancer, and >80% of new cervical cancers are detected, most of which are at advanced stages, WHO states that if women worldwide received a lifetime gynecological examination, we could eliminate 50% of cervical cancers. This is why it is so important to have cervical screening. In developed countries, the mortality rate has dropped by 50% after screening for cervical cancer. In the United States, for example, cervical cancer was the third most common cause of death in the 1950s, and after standardized cervical screening, it was reduced to the 15th most common cause of death by 2006. In China, due to the lack of screening procedures for precancerous lesions and early cancers; the low level of screening quality; and the lack of self-protection awareness and misconceptions about cervical lesions among women and their families. Standardized screening is still weak. Cervical screening is mainly to screen out patients at high risk of developing cervical precancer and cervical cancer, and to treat patients with precancer and early cancer even if they have them. Cervical screening should include the following components: cytology, colposcopy, and final diagnosis based on pathology. Cytology is the “navigator” of cervical screening, and abnormal cytology results become the basis for the need for further testing. If available, high-risk HPV testing can be performed, and if positive, colposcopy should be performed if only the cytology is negative. After pathological examination, finally aggressive treatment or follow-up should be taken depending on the pathological findings. Finally, it should be emphasized that the so-called “cervical erosion” should not be treated blindly without cervical screening to prevent precancerous lesions and early cervical cancer from being missed. Among the severe cervical precancerous lesions treated at Peking University People’s Hospital, 9 cases had smooth cervical cervix after physiotherapy, indicating that precancerous lesions may occur after physiotherapy for “celiac disease” despite a smooth cervix.