[Cervical cancer].

The epidemiologic data demonstrated by SEER clearly show a decrease of cervical cancer over the decades due to widespread cervical cancer screening with a pap smear, although there is currently a shift in the age distribution resulting in an increase of cervical cancer among younger women, and a lower screening rate is a problem, particularly in Japan. Another peculiar trend is an increase of endocervical adenocarcinomas, and the underlying cause of this trend is still unknown. A screening program, employing the Bethesda system terminology and liquid-based cytology, combined with HPV DNA testing and p16(INK4a) immunohistochemistry/ cytochemistry, and a management guideline proposed by ASCCP, has been contributing to the early detection of cervical cancers. However, it should be kept in mind that an HPV-targeted strategy is effective only for squamous lesions, which is mostly HPV-driven neoplasms, and that unusual HPV-negative adenocarcinomas, including gastric, clear cell, and mesonephric types, are a pitfall of HPV DNA testing and vaccination. Therefore, potential biomarkers, which can be applied for both squamous and glandular lesions, are awaited. The gastric type of adenocarcinoma of the cervix, a recently described subtype, is a distinct entity showing an aggressive clinical behavior, and, importantly, is estimated to be more frequent than in western countries.