The Changing Face of Cervical Cancer Screening in the United States

Restricted access
With the introduction of widespread Pap smear screening starting in the 1940s, the United States has seen at least a 50% reduction in the incidence and mortality of invasive cervical cancer. In light of the ease of sampling, the long pre-malignant phase of cervical cancer, and well-tolerated treatment options for pre-invasive disease, cervical cancer screening has served as a model for screening for other malignancies.For some women, it also serves as the cornerstone for annual routine visits with gynecologists. Both patients and gynecologists have been taught that a yearly Pap test is important, and it can serve as the backbone of care. Unfortunately, however, access to screening and treatment for cervical cancer continues to be an issue for some women in the United States. Approximately 60% of women with invasive cancer had not undergone a Pap test in the 5 years preceding their diagnosis or have never undergone a Pap test.1The long history of Pap tests has also taught us a number of lessons. We have learned that cytologic screening is hardly perfect. In a study by Nanda et al.2 the sensitivity of a single test was 51%, and this was subsequently confirmed in a pooled analysis of European and Canadian studies by Cuzick et al.3 One way to compensate for this poor sensitivity is by using serial screening; the sensitivity of cytology increases to 76% with 2 consecutive annual Pap tests and 88% with 3 consecutive tests.Just adding tests and procedures, however, is not always the...

Warner K. Huh, MD, is Professor in the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology at the University of Alabama at Birmingham (UAB) and a Senior Scientist in the UAB Comprehensive Cancer Center. Dr. Huh's research interests include vaccines for cervical neoplasia and the development of novel screening and treatment strategies for gynecologic malignancies. He has authored or co-authored more than 95 articles, including publications in the Journal of the National Cancer Institute, Cancer, Clinical Cancer Research, Gynecologic Oncology, and Obstetrics & Gynecology. He is the recipient of an R01 research grant from the National Institutes of Health/National Cancer Institute and an American Cancer Society Research Scholars Grant. He is co-leader of several projects and sits on the steering committee of the Johns Hopkins-UAB Cervical Cancer Specialized Programs of Research Excellence (SPORE) program.
  • 1.

    SawayaGFSungHYKearneyKA. Advancing age and cervical cancer screening and prognosis. J Am Geriatr Soc2001;49:14991504.

  • 2.

    NandaKMcCroryDCMyersER. Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: a systematic review. Ann Intern Med200016;132:810819.

    • Search Google Scholar
    • Export Citation
  • 3.

    CuzickJClavelCPetryKU. Overview of the European and North American studies on HPV testing in primary cervical cancer screening. Int J Cancer2006;119:10951101.

    • Search Google Scholar
    • Export Citation
  • 4.

    American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 463: Cervical cancer in adolescents: screening, evaluation, and management. Obstet Gynecol2010;116:469472.

    • Search Google Scholar
    • Export Citation
  • 5.

    BulkmansNWRozendaalLSnijdersPJ. POBASCAM, a population-based randomized controlled trial for implementation of high-risk HPV testing in cervical screening: design, methods and baseline data of 44,102 women. Int J Cancer2004;110:94101.

    • Search Google Scholar
    • Export Citation
  • 6.

    SankaranarayananRNeneBMShastriSS. HPV screening for cervical cancer in rural India. N Engl J Med2009;360:13851394.

  • 7.

    KitchenerHCAlmonteMThomsonC. HPV testing in combination with liquid-based cytology in primary cervical screening (ARTISTIC): a randomised controlled trial. Lancet Oncol2009;10:672682.

    • Search Google Scholar
    • Export Citation
  • 8.

    NauclerPRydWTörnbergS. Efficacy of HPV DNA testing with cytology triage and/or repeat HPV DNA testing in primary cervical cancer screening. J Natl Cancer Inst2009;101:8899.

    • Search Google Scholar
    • Export Citation
  • 9.

    LeinonenMNieminenPKotaniemi-TalonenL. Age-specific evaluation of primary human papillomavirus screening vs conventional cytology in a randomized setting. J Natl Cancer Inst2009;101:16121623.

    • Search Google Scholar
    • Export Citation
  • 10.

    MayrandMHDuarte-FrancoERodriguesI. Human papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. N Engl J Med2007;357:15791588.

    • Search Google Scholar
    • Export Citation
  • 11.

    OgilvieGSvan NiekerkDJKrajdenM. A randomized controlled trial of Human Papillomavirus (HPV) testing for cervical cancer screening: trial design and preliminary results (HPV FOCAL Trial). BMC Cancer2010;10:111.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 63 63 5
PDF Downloads 3 3 0
EPUB Downloads 0 0 0