For many years, cytology has been the established method used for annual cervical cancer screening. Evidence now shows that sexually transmitted human papillomavirus (HPV) infection is almost always responsible for cases of cervical cancer with two types most responsible. Many members of the health care community are now calling for a shift in screening procedures to reflect our improved understanding of cervical cancer development.
In a special issue of Preventive Medicine, experts look at the emerging evidence that HPV screening may be a better way than Pap tests for doctors to screen for cervical cancer. As Guest Editor for the special issue, Dr. Mark Schiffman, senior investigator in the Clinical Genetics Branch at the National Cancer Institute, wrote, "HPV testing is coming and the role of cytology will be reduced; however, this collection of evidence summaries, guidelines, and editorials aims to illustrate the variety of ways the changeover will occur globally. More broadly, this special issue illustrates the importance and limits of epidemiology as the 'basic science of public health.' The conclusion is that given an established epidemiologic set of scientific facts and validated prevention tools, real-life concerns that vary by region will determine which public health strategies are used."
Dr. Schiffman's straightforward editorial touches on the potentially controversial elements of HPV testing as a primary screening method for cervical cancer. "It turns out that detailed implementation of HPV primary screening to replace cytology reveals many choices reliant on value judgments and not risk assessment, particularly when resources are limited," said Dr. Schiffman. "Controversial areas include acceptable costs and effort, choices of safety and action thresholds, and the role of the clinician in the integration of test data vs apps and guidelines."
Check out some of the articles