title: Risk assessment to guide the prevention of cervical cancer.
abstract: Advances in screening and diagnosis make it increasingly possible to prevent cervical cancer. However, if misused or poorly understood, these new tools will only increase costs and potentially harm patients without benefit. As a framework for standardized care that maximizes patient safety and well-being, we propose that a risk model be adopted to guide clinical management now and in the future. The model would use thresholds of increasing risk for cervical precancer and treatable cancer to guide clinical decision making for screening intensity, diagnostic evaluation, or treatment. Experts would decide on these risk thresholds and stratum based on the patient risk to benefit, independent of current (e.g., cytology, carcinogenic human papillomavirus testing, and colposcopy) and future methods of measuring risk. A risk management model for cervical cancer prevention, based on appropriate clinical actions that correspond to risk stratum, can result in better allocation of resources to and increased safety for women at the greatest risk and increased well-being for women at the lowest risk.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892-7234, USA. castlep@mail.nih.gov
authors.forename: Philip E
authors.initials: PE
authors.lastname: Castle
authors.forename: Mario
authors.initials: M
authors.lastname: Sideri
authors.forename: Jose
authors.initials: J
authors.lastname: Jeronimo
authors.forename: Diane
authors.initials: D
authors.lastname: Solomon
authors.forename: Mark
authors.initials: M
authors.lastname: Schiffman
mesh_terms: D000465:Algorithms; D003127:Colposcopy; D005260:Female; D006801:Humans; D018307:Neoplasms, Squamous Cell / Q000175:diagnosis / Q000517:prevention & control*; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000175:diagnosis*; D018570:Risk Assessment; D012307:Risk Factors; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000601:surgery; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D014626:Vaginal Smears