Cervical Cancer Prevention: Better Tests, Better Tools, and More Equitable Outcomes

Extract

In 1941, Dr George Papanicolaou and Dr Herbert Traut published a landmark study concerning a new diagnostic test for the early detection of cervical cancer ( 1 ). This test became commonly known as the “Pap smear.” This screening test was responsible for a remarkable decrease in cervical cancer mortality in well-screened populations, with an approximately 80% decrease in the United States in the second half of the 20th century. Despite its value as a cancer prevention tool, the Pap smear has several well-known shortcomings. Cytological screening for cervical dysplasia and cancer requires infrastructure and training for the collection and interpretation of samples. The Pap smear is also less than 100% sensitive for the detection of clinically significant premalignant cervical disease. This problem requires that the test be repeated at frequent intervals. Diagnostic testing for human papillomavirus (HPV) infection has emerged as an alternative to the venerable Pap smear. Multiple publications over the past decade have demonstrated the sensitivity of the HPV test for the detection of cervical dysplasia and cancer. In one study in rural India ( 2 ), one round of HPV testing was superior in reducing cervical cancer mortality when compared with the Pap smear.