Elsevier

The Lancet Oncology

Volume 2, Issue 1, January 2001, Pages 27-32
The Lancet Oncology

Review
Cervical-cancer screening beyond the year 2000

https://doi.org/10.1016/S1470-2045(00)00192-3Get rights and content

Summary

Evidence-based studies have shown that new techniques for cervical cancer screening have a higher diagnostic yield than conventional cervical cytology (Pap test). Automated screening devices that use liquid-based, thin-layer cytology and human papillomavirus DNA testing are likely to become the standard for routine primary screening for cervical cancer and its precursors in the 21st century. The increased initial expense of the new techniques will most certainly be absorbed by instituting longer intervals for safe primary screening, in both low-risk and high-risk populations. To make modern screening programmes even more effective, we must promote extensive public awareness campaigns about cervical cancer, a preventable disease.

Section snippets

Thin-layer, liquid-based cytology

The basic principle and advantage of this technique over the conventional Pap test is that the sample removed from the cervix is not placed on a glass slide but is rinsed from the sampler into a vial (Figure 1), which contains a cell-preserving transport fluid, thus permitting the collection of virtually all cellular material in an optimum state. In the conventional Pap test, at best only 20% of the cells are smeared onto the glass slide and the remaining 80% are lost with the discarded

Prospects

The currently available scientific data show that the new techniques are likely to improve detection of cervical cancer and its precursors. The incidence of late-stage precancer (high-grade squamous intraepithelial lesions) and early-stage invasive disease peaks at age 35 to 45 years. The greatly improved sensitivity of the double test (HPV/Pap) should therefore lead to the detection of most of the clinically important lesions in this cohort of women. Removal of these lesions should avert many

Problems and solutions

Up to now, the rationale for developing new techniques was to provide better diagnostic accuracy which in turn might have the potential to modify our current policies with respect to cervical cancer screening programmes. In the short term, there will continue to be improvements in the new techniques to achieve their maximum clinical usefulness. Also, prospective data are forthcoming to help identify the most adequate techniques (and their combinations) and the most appropriate testing intervals

Conclusions

It is only a matter of time before one of the last bastions of morphology— manual cytology— will give way to new methods. Indeed, we are witnessing a major shift in disease detection and prognosis. Automated, robotic, and molecular-based techniques are taking the forefront in detecting cervical cancer and its precursors and will become an essential and indispensable part of modern screening programmes. These will use liquid-based thin-layer cytology, computer-assisted automated screening

Search strategy and selection criteria

Evidence-based information on conventional and new technologies used for primary and secondary screening for cervix cancer and its precursors were included. Only large, clinical trials involving more than 1000 women, published in English after 1990 were included.

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