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Cervical cancer screening at crossroads
Author(s) -
Lynge Elsebeth,
Rygaard Carsten,
Baillet Miguel VazquezPrada,
Dugué PierreAntoine,
Sander Bente Braad,
Bonde Jesper,
Rebolj Matejka
Publication year - 2014
Publication title -
apmis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 88
eISSN - 1600-0463
pISSN - 0903-4641
DOI - 10.1111/apm.12279
Subject(s) - medicine , cervical cancer , vaccination , cervical intraepithelial neoplasia , gynecology , randomized controlled trial , cancer , population , incidence (geometry) , cancer screening , cytology , disease , cervical screening , obstetrics , oncology , immunology , pathology , environmental health , physics , optics
Cervical screening has been one of the most successful public health prevention programmes. For 50 years, cytology formed the basis for screening, and detected cervical intraepithelial lesions ( CIN ) were treated surgically to prevent progression to cancer. In a high‐risk country as D enmark, screening decreased the incidence of cervical cancer from 34 to 11 per 100 000, age‐standardized rate ( W orld S tandard P opulation). Screening is, however, also expensive; D enmark (population: 5.6 million) undertakes close to half a million tests per year, and has 6–8 CIN ‐treated women for each prevented cancer case. The discovery of human papillomavirus ( HPV ) as the cause of cervical cancer dramatically changed perspectives for disease control. Screening with HPV testing was launched around 1990, and preventive HPV vaccination was licensed in 2006. Long‐term randomized controlled trials ( RCT ) demonstrated that HPV testing provides better protection against cervical cancer than cytology, but it requires extra repeated testing. HPV vaccination RCT s, furthermore, have proved that HPV vaccination protects against vaccine‐type high‐grade CIN in women vaccinated prior to sexual activity, but less so in women vaccinated later. The challenge now is therefore to find an algorithm for screening of a heterogeneous population including non‐vaccinated women; women vaccinated prior to start of sexual activity; and women vaccinated later.