Cervical cancer prevention
Promises and perils in a changing landscape

Eduardo L. Franco, MPH, DrPH, Marie-Hélène Mayrand, MD, MSc, FRCSC
and Helen Trottier, MSc PhD

Cervical cancer is the malignant neoplastic disease for which public health prevention initiatives have had the greatest success. Organized or opportunistic screening with the Papanicolaou cytology technique (Pap test) has reduced the cervical cancer burden by about 75% in highincome countries during the last 50 years.

 

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Top-line summary
Universal deployment of organized or opportunistic screening with Pap cytology in high-income countries has substantially reduced cervical cancer morbidity and mortality during the last 50 years. Cervical cancer remains a critical public health problem, however, because in many low-income countries, Pap screening has not yet been effectively implemented or it has failed to reduce cervical cancer rates. Infection with certain human papillomavirus (HPV) types is now recognized as a necessary cause of this disease. Testing for the presence of the D NA of these HPVs in genital samples shows great promise as a screening tool, with much greater sensitivity but slightly lower specificity than Pap cytology. Combining both methods has the potential to improve the negative predictive value of cytology, thus allowing testing intervals to increase and lowering program costs with acceptable safety. As well, recent research on the safety and efficacy of candidate prophylactic vaccines against HPV has shown nearly 100% efficacy in preventing persistent infections and development of cervical precancerous lesions. Licensed HPV vaccines will be available in 2006–7. To achieve cost-effectiveness, policymakers are urged to consider screening and immunization as integrated preventive approaches.
 
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