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Looking ahead: A case for human papillomavirus testing of self‐sampled vaginal specimens as a cervical cancer screening strategy
Author(s) -
Gravitt Patti E.,
Belinson Jerome L.,
Salmeron Jorge,
Shah Keerti V.
Publication year - 2011
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.25974
Subject(s) - medicine , cervical cancer , cervical screening , cancer screening , gynecology , public health , population , cancer , human papillomavirus , family medicine , intensive care medicine , environmental health , nursing
Abstract Even in the era of highly effective human papillomavirus (HPV) prophylactic vaccines, substantial reduction in worldwide cervical cancer mortality will only be realized if effective early detection and treatment of the millions of women already infected and the millions who may not receive vaccination in the next decade can be broadly implemented through sustainable cervical cancer screening programs. Effective programs must meet three targets: ( i ) at least 70% of the targeted population should be screened at least once in a lifetime, ( ii ) screening assays and diagnostic tests must be reproducible and sufficiently sensitive and specific for the detection of high‐grade precursor lesions ( i.e ., CIN2+), and ( iii ) effective treatment must be provided. We review the evidence that HPV DNA screening from swabs collected by the women in their home or village is sufficiently sound for consideration as a primary screening strategy in the developing world, with sensitivity and specificity for detection of CIN2+ as good or better than Pap smear cytology and VIA. A key feature of a self‐collected HPV testing strategy (SC‐HPV) is the move of the primary screening activities from the clinic to the community. Efforts to increase the affordability and availability of HPV DNA tests, community education and awareness, development of strong partnerships between community advocacy groups, health care centers and regional or local laboratories, and resource appropriate strategies to identify and treat screen‐positive women should now be prioritized to ensure successful public health translation of the technologic advancements in cervical cancer prevention.