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In page Cervical cancer staging:

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The most recent updates to cervical cancer staging included in the 2018 edition marked a departure from a system based mainly on clinical evaluation to one that allows imaging and pathological methods to help determine tumor size and extent of disease to assign the stage. A major topic of debate was the impact that newer diagnostic modalities would have on low- and middle-income countries, which bear most of the disease burden.[3] The final recommendations make findings from imaging and pathology optional for staging rather than a requirement.[citation needed]