THE INCIDENCE of and mortality from cervical cancer in the United States have decreased dramatically over the past 40 years, in part because of early diagnosis and treatment of cervical cancer precursor lesions. The success of cervical cytological screening has served as a model for early diagnosis of other types of cancer. Although numerous studies have shown that lack of cytological screening is a major risk factor for the development of invasive cervical cancer,1-3 it is important to emphasize that none of the screening, diagnostic, or therapeutic techniques used in medicine are perfect. Accordingly, a few women will develop cervical cancer despite adherence to accepted screening protocols. In addition, problems inherent with sampling, interpretation, and effective clinical follow-up preclude total prevention of cervical cancer.
In recent years it has become evident that the cost and morbidity associated with the detection and treatment of low-grade cervical lesions have escalated, probably
Kurman RJ, Henson DE, Herbst AL, Noller KL, Schiffman MH, Bonfiglio T, Buck H, Crum C, Curtin JP, Greenberg M, Hatch K, Henson DE, Jenson AB, Johnson P, Jones H, Kaminetsky H, Klein L, Koss L, Krumholz B, Lee N, Luff R, Mandelblatt J, Reid R, Richart R, Sedlacek T, Sneiderman C, Solomon D, Stoler M, Taub F, Trimble E, Tucker E, Twiggs LB, Wilkinson E, Atkinson B, Averette HE, Creasman W, Fryhofer S, Noy J, Nielsen M, Noller K, Park R, Westhoff D. Interim Guidelines for Management of Abnormal Cervical Cytology. JAMA. 1994;271(23):1866-1869. doi:10.1001/jama.1994.03510470070037