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Developments in Cervical and Ovarian Cancer Screening: Implications for Current Practice
Like the diseases themselves, the models of screening for cervical and ovarian cancer are distinct. Recent research involving these conditions, however, may suggest changes in future screening approaches. Evidence about the standard testing model for cervical cancer is being revisited, and although ovarian cancer screening is still nascent, with no definitive recommended course of action, researchers are moving closer to conclusions. The evolving bodies of evidence, combined with the fact that the at-risk populations for each disease are similar, have distinct implications for internal medicine practice.
Cervical Cancer
The Papanicolaou (Pap) test has had a striking impact on the risk for developing and dying of cervical cancer. In the United States, widespread use of the Pap test has decreased the incidence and mortality rates by 40% since 1973. Today, an American woman has a 0.83% lifetime risk for the disease and a 0.27% risk for dying of it. The contribution of the Pap test to these positive outcomes is so great that it is one of the few interventions to receive an “A” recommendation from the U.S. Preventive Services Task Force, even though it has never been evaluated in a randomized clinical trial (Evaluation of cervical cytology. Rockville, MD: AHCPR; 1999). Researcher George Sawaya, MD, commented, “Mortality from no other malignancy has been reduced so much from the concerted efforts of practitioners applying an innovative technology” (Obstet Gynecol. 1999;94:307-10). However, an estimated 12 800 cases of invasive cervical cancer will be identified this year, and nearly 5000 women will die of the disease, most due to lack of screening.
In the 1980s, human papillomavirus (HPV) DNA was identified in cervical cancer, and researchers speculated that the virus could act as an agent for the disease. Subsequent studies have established that link. More than 90% of precursor lesions and invasive cervical malignancies have …
