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Screening for cervical cancer remains an important health and economic concern in the United States and throughout the world. Molecular and epidemiologic studies have solidified the association between infection with high-risk strains of human papilloma virus (HPV) and cervical squamous cell carcinoma. Cervical cancer has a well-demonstrated pre-malignant phase of many years, which allows early detection and intervention. Pap smear cytology has been the basis of cervical cancer screening programs, but it suffers from low sensitivity. Tests have been developed that detect high-risk HPV DNA in cervical samples with high sensitivity. Large-scale studies have shown the utility of HPV DNA testing in the management of women with Pap smear results showing atypical squamous cells of undetermined significance. New screening options include testing for high-risk HPV DNA in combination with cytology. Clinical trials and cost-modeling studies are also under way to evaluate the use of HPV detection alone as the primary screening test. The recent introduction of an HPV vaccine may also eventually impact screening algorithms. |
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