Page 76 - Screening for Cervical Cancer: Systematic Evidence Review

Chapter IV. Discussion

• Continued study of the natural history of cervical dysplasia and HPV infection;

• Investigation of the consequences of diagnosis, evaluation, and treatment of low-

grade cervical intraepithelial abnormalities or detection of HPV with respect to

potential psychological distress, sexual behavior, future reproductive and sexual

function, and demands on the health care system;

• Trials of preventive interventions such as HPV vaccination, use of topical retinoids,

and smoking cessation intervention among women with CIN;

• Outcomes studies evaluating use of HPV testing to guide cessation of Pap testing

among older women, and

• Evaluation of health care systems methods for documenting the prior Pap test history

of individual women, to promote appropriate screening and use of screening

resources.

Advances in detecting high-grade lesions and minimizing overscreening must go hand-in-

hand with active research on promoting uptake and continuance of appropriate Pap testing. The

majority of cervical cancers still occur among women who are unscreened, who are inadequately

screened, and who do not receive appropriate follow-up for abnormal screening test results. As

Table 5 summarized in Chapter 3, a robust literature, including randomized intervention trials,

provides insight into methods to promote uptake and continuance and to improve follow-up.

New approaches to screening and new tools for screening need to be deployed within a care

system that improves documentation of women’s screening status, enhances the knowledge of

both patients and providers, and optimizes reaching the unreached.

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