A critical assessment of screening methods for cervical neoplasia.
The objective of cervical cancer screening is to reduce cervical cancer incidence and mortality by detecting and treating precancerous lesions. Conventional cytology is the most widely used cervical cancer screening test. Although cytology has been effective in reducing the incidence of and mortality from cervical cancer in developed countries in both opportunistic and--more dramatically--organized national programs, it has been less successful and largely ineffective in reducing disease burden in low-resource settings where it has been implemented. Liquid-based cytology, testing for infection with oncogenic types of human papillomaviruses, visual inspection with 3-5% acetic acid, magnified visual inspection with acetic acid, and visual inspection with Lugol's iodine have been evaluated as alternative tests. Their test characteristics, and the applications and limitations in screening, are discussed with an emphasis on the work of the Alliance for Cervical Cancer Prevention over the past 5 years.
Sankaranarayanan
R
R
International Agency for Research on Cancer (IARC), 150 cours Albert Thomas, 69372 Lyon Cedex 08, France. sankar@iarc.fr
Gaffikin
L
L
Jacob
M
M
Sellors
J
J
Robles
S
S
D003584:Cytological Techniques; D015344:DNA Probes, HPV; D003906:Developing Countries; D005260:Female; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000379:methods*; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000517:prevention & control*; D014626:Vaginal Smears
D015344:DNA Probes, HPV