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JAMA Insights
Women's Health
May 28, 2019

Cervical Cancer Screening: More Choices in 2019

Author Affiliations
  • 1Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
  • 2UCSF Center for Healthcare Value, San Francisco, California
JAMA. 2019;321(20):2018-2019. doi:10.1001/jama.2019.4595

Widespread adoption of population-based screening has been associated with marked decreases in cervical cancer incidence and mortality in the United States over the last few decades. Despite these gains, an estimated 13 240 US women were diagnosed with cervical cancer in 2018, and 4170 died from the disease.1

A large body of consistent evidence implicates infection with high-risk types of human papillomavirus (hrHPV) as the causative agent in cervical cancer. These infections are common, occurring in the majority of sexually active women over their lifetime.2 While most infections resolve without clinical consequence over a period of several years, persistent infections can lead to high-grade precancerous cervical lesions (such as cervical intraepithelial neoplasia [CIN] grades 2 and 3) that can progress to cervical cancer. Approximately 30% of CIN grade 3 lesions progress to invasive cancer over a 30-year period.2 This slow progression allows many opportunities for these lesions to be detected and treated, thereby disrupting the trajectory to cancer.

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