title: Evolution of cervical cancer screening and prevention in United States and Canada: implications for public health practitioners and clinicians.
abstract: OBJECTIVE
  Declines in cervical cancer incidence and mortality in Canada and in the United States have been widely attributed to the introduction of the Papanicolaou (Pap) test. This article reviews changes in screening and introduction of HPV vaccination.
  
  
  METHODS
  Sentinel events in cervical cancer screening and primary prevention through HPV vaccination in the US and Canada are described.
  
  
  RESULTS
  Despite commonalities, cervical cancer screening and prevention differ between the two countries. Canada has a combination of opportunistic and organized programs at the provincial and territorial level, while the US has opportunistic screening and vaccination systems. In the US, the HPV test along with the Pap test (co-testing) is part of national recommendations for routine cervical cancer screening for women age 30 and older. Co-testing is not being considered anywhere in Canada, but primary HPV testing is currently recommended (but not implemented) in one province in Canada.
  
  
  CONCLUSIONS
  Many prevention strategies are available for cervical cancer. Continued public health efforts should focus on increasing vaccine coverage in the target age groups and cervical cancer screening for women at appropriate intervals. Ongoing evaluation will be needed to ensure appropriate use of health resources, as vaccinated women become eligible for screening.
authors: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, GA, USA. Electronic address: yzs2@cdc.gov.
authors: M
authors: M
authors: Saraiya
authors: M
authors: M
authors: Steben
authors: M
authors: M
authors: Watson
authors: L
authors: L
authors: Markowitz
mesh_terms: D000328:Adult; D002170:Canada; D003431:Cross-Cultural Comparison; D055088:Early Detection of Cancer / Q000639:trends*; D005260:Female; D006801:Humans; D015994:Incidence; D030361:Papillomavirus Infections / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000008:administration & dosage; D015980:Public Health Practice; D015996:Survival Rate; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control*; D014600:Utilization Review; D014626:Vaginal Smears / Q000706:statistics & numerical data / Q000639:trends*
chemical_list: D053918:Papillomavirus Vaccines
keywords: HPV; North America; Screening; US and Canada; Vaccination
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