The basic elements of a correct diagnosis: From cytohistopathology to screening

Abstract

Although most women infected with the Human Papillomavirus (HPV) become negative within 2 years, women with persistent high-risk (HR) infections are at greatest risk for developing cervical cancer. Since the identification of HPV as the necessary cause of cervical cancer, HPV-based technology has become the center of novel primary and secondary cervical cancer prevention strategies by the introduction of HPV testing in screening and of HPV vaccines in preadolescent girls and young women. If implemented widely and wisely, the deployment of these protocols has the potential to complete Papanicolaou's goal of cervical cancer eradication by extending the benefits of prevention to the developing populations of the world as reported by Castellsagué (Gynecol Oncol 110:S4-S7, 2008). Even in the era of highly effective HPV prophylactic vaccines, substantial reduction in worldwide cervical cancer mortality will only be realized if effective early detection and treatment of the millions of women already infected. The millions who may not receive vaccination in the next decade can be broadly implemented through sustainable cervical cancer screening programs. Effective programs must meet three targets: (1) at least 70% of the targeted population should be screened at least once in a lifetime, (2) screening assays and diagnostic tests must be reproducible and sufficiently sensitive and specific for the detection of high-grade (HG) precursor lesions (i.e. cervical intraepithelial neoplasia, CIN2+), and 3) effective treatment must be provided. Efforts to increase the affordability and availability of HPV deoxy-ribonucleic acid (DNA) tests, community education and awareness, development of strong partnerships between community advocacy groups, health care centers and regional or local laboratories, and resource-appropriate strategies to identify and treat screen-positive women should now be prioritized to ensure successful public health translation of the technologic advancements in cervical cancer prevention as reported by Gravitt et al. (Int J Cancer 129:517-527, 2011).