Present standards for cervical cancer screening

Abstract

Survival rates for cancer of the uterine cervix have improved over the last 40 years largely because of the impact of screening measures such as the Pap smear. The ability to screen and treat women for preinvasive disease, cervical dysplasia, is the key factor leading to the reduction in the incidence of invasive cervical cancer. More recently, the ability to test women for the causative agent, the human papilloma virus, has emerged as a potential screening tool. New research has focused on new technologies for Pap smear screening such as thin layer technology, the appropriate intervals for screening, and the appropriate methods of incorporation of human papilloma virus testing into the screening protocols. Reviews of published studies evaluating the efficacy of new technologies suggest that there is still insufficient information to confirm improved outcome; however, results to date suggest that thin layer Pap smear technology may improve sensitivity in the detection of cervical dysplasia. Automated rescreening technologies in use may decrease the number of false-negative Pap smears and are an option for laboratories. Various professional groups and countries have differing recommendations on the interval for screening, primarily on the basis of cost-effectiveness. Some of the most important new information this year regarding cervical cancer screening includes the new Bethesda System for the reporting of Pap smears and the new guidelines for the management of the abnormal Pap smear by the American Society of Colposcopy and Cervical Pathology. These guidelines incorporate human papilloma virus testing based on a multicenter trial documenting its efficacy in the triage of women with atypical squamous cells on Pap smear. These recommendations are reviewed along with the current literature on cervical cancer screening.