Cervical cancer screening

There is abundant evidence that cervical cancer screening with conventional cytology (CC) has reduced mortality from cervical cancer. Based on the evidence, CC has been implemented as a modality of the population-based screening for the last several decades in Japan. Several issues are currently faced during screening. For instance, very low coverage is one of the greatest unsolved problems. At the same time, a reliable system is required to monitor specimen adequacy and to calculate detection rates of not only invasive cancer, but also cervical intraepithelial neoplasia (CIN), for the quality control and evaluation of screening efficacy. Recently, two new modalities may be applicable for cervical cancer screening. One is liquid-based cytology (LBC) and the other is the HPV test. LBC and CC did not differ significantly in terms of sensitivity and specificity for detection of CIN2+or CIN3+. HPV tests are superior to CC in sensitivity but are inferior in specificity for detection of CIN2+or CIN3+. Because there is a possibility reducing mortality from and incidence of invasive cervical cancer, implementation of these modalities to Japan should be taken into consideration. Prior to this, however, it is necessary to organize a system to compare performance indicators reflecting the effectiveness of the new modalities to those of CC in a population-based screening. Also, these results must be disclosed for a steady perspective on the cervical cancer screening in Japan.