Cervix cancer screening v. 10

List of participants . . . . . . . . . . . . . . . . . . . . . . . . . ix Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi 1. Cervical cancer and screening . . . . . . . . . . . . . 1 Cervical cancer incidence and mortality worldwide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Pathology of cervical neoplasia . . . . . . . . . . . . . . 9 Diagnosis and treatment of cervical preinvasive and invasive disease . . . . . . . . . . . . . . . . . . . . . 18 The etiology of cervical cancer . . . . . . . . . . . . . 26 Principles of screening . . . . . . . . . . . . . . . . . . . 45 Natural history of cervical cancer . . . . . . . . . . . . 46 Considerations for screening programmes . . . . . 57 2. Screening tests . . . . . . . . . . . . . . . . . . . . . . . . 59 Cervical cytology . . . . . . . . . . . . . . . . . . . . . . . . 59 Visual inspection . . . . . . . . . . . . . . . . . . . . . . . . 76 Colposcopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Cervicography . . . . . . . . . . . . . . . . . . . . . . . . . . 90 . HPV DNA testing . . . . . . . . . . . . . . . . . . . . . . . . 93 Combinations of different modalities . . . . . . . . . 109 3. Use of screening for cervical cancer . . . . . . 117 Delivery and uptake of screening . . . . . . . . . . . 117 Behavioural considerations in screening . . . . . 147 4. Efficacy of screening . . . . . . . . . . . . . . . . . . . 163 Methodology and analytical issues in assessment of efficacy . . . . . . . . . . . . . . . . . . 163 Cytological screening . . . . . . . . . . . . . . . . . . . 168 Visual inspection . . . . . . . . . . . . . . . . . . . . . . . 183 Human papillomavirus testing . . . . . . . . . . . . . 186 Other screening methods . . . . . . . . . . . . . . . . .191 Efficacy of screening among HIV-positive women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 5. Effectiveness of screening in populations . . 201 Incidence and mortality trends in relation to screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201 Issues in the implementation of screening . . . . 212 Hazards of screening programmes . . . . . . . . . 214 Performance evaluation . . . . . . . . . . . . . . . . . . 217 Economic evaluation and cost-effectiveness of cervical cancer screening . . . . . . . . . . . . . . . . 223 6. Summary of data . . . . . . . . . . . . . . . . . . . . . . 227 7. Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . 237 8. Recommendations for public health implementation and further research . . . . . 239 . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243 Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293 Working procedures . . . . . . . . . . . . . . . . . . . . . . 299