title: Cervical cancer screening at crossroads.
abstract: 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 Denmark, screening decreased the incidence of cervical cancer from 34 to 11 per 100,000, age-standardized rate (World Standard Population). Screening is, however, also expensive; Denmark (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 RCTs, 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.
authors.affiliation: Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Elsebeth
authors.initials: E
authors.lastname: Lynge
authors.forename: Carsten
authors.initials: C
authors.lastname: Rygaard
authors.forename: Miguel Vazquez-Prada
authors.initials: MV
authors.lastname: Baillet
authors.forename: Pierre-Antoine
authors.initials: PA
authors.lastname: Dugué
authors.forename: Bente Braad
authors.initials: BB
authors.lastname: Sander
authors.forename: Jesper
authors.initials: J
authors.lastname: Bonde
authors.forename: Matejka
authors.initials: M
authors.lastname: Rebolj
mesh_terms: D000293:Adolescent; D000328:Adult; D003718:Denmark / Q000453:epidemiology; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000517:prevention & control; D053918:Papillomavirus Vaccines; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D014611:Vaccination; D014626:Vaginal Smears; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000601:surgery
chemical_list: D053918:Papillomavirus Vaccines
keywords: Cervix uteri; cancer; cytology; human papillomavirus; screening