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. 2021 Nov 11;385(20):1908-1918.
doi: 10.1056/NEJMsr2030640.

The IARC Perspective on Cervical Cancer Screening

Véronique Bouvard  1 , Nicolas Wentzensen  1 , Anne Mackie  1 , Johannes Berkhof  1 , Julia Brotherton  1 , Paolo Giorgi-Rossi  1 , Rachel Kupets  1 , Robert Smith  1 , Silvina Arrossi  1 , Karima Bendahhou  1 , Karen Canfell  1 , Z Mike Chirenje  1 , Michael H Chung  1 , Marta Del Pino  1 , Silvia de Sanjosé  1 , Miriam Elfström  1 , Eduardo L Franco  1 , Chisato Hamashima  1 , Françoise F Hamers  1 , C Simon Herrington  1 , Raúl Murillo  1 , Suleeporn Sangrajrang  1 , Rengaswamy Sankaranarayanan  1 , Mona Saraiya  1 , Mark Schiffman  1 , Fanghui Zhao  1 , Marc Arbyn  1 , Walter Prendiville  1 , Blanca I Indave Ruiz  1 , Isabel Mosquera-Metcalfe  1 , Béatrice Lauby-Secretan  1
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The IARC Perspective on Cervical Cancer Screening

Véronique Bouvard et al. N Engl J Med. .
No abstract available

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Figures

Figure 1.
Figure 1.. Schematic Representation of the Review and Evaluation Process of the IARC Handbooks for Secondary Prevention of Cervical Cancer.
WHO denotes World Health Organization.
Figure 2.
Figure 2.. Schematic Representation of the Natural History of Cervical Cancer.
The age at onset of human papillomavirus (HPV) infections is roughly the average societal age of first intercourse (Panel A). HPV infections are very common, and infections — even with carcinogenic types — are usually benign. A high proportion of infections disappear within a few months, with a median clearance of most screen‑detected infections of about 1 year and a large fraction undetectable within 2 to 3 years. Only a very small proportion of carcinogenic HPV infections are detectable after more than 5 years (without progression to precancer). Progression to precancer depends on the HPV type and time of persistence; most precancers will regress with time. Only a very small proportion of precancers will evolve into cancer, again depending on HPV type and the duration of persistent infection. The whole process from HPV acquisition to cancer diagnosis typically takes decades, although more rapid transitions have also been observed. The measurable transitions between the normal cervix and HPV infection can be named simply appearance and disappearance of HPV detection, to acknowledge the limitations of existing measurement assays and the potential for reactivation of latent infections. The transitions between infection and precancer can be described as progression to and regression of precancer (Panel B). Invasion is considered a typically irreversible natural history transition when HPV‑positive cells cross the basement membrane. The currently available tests for cervical cancer screening detect lesions at different stages in the process of carcinogenesis (Panel C). HPV tests (DNA or mRNA) detect the presence of the virus immediately after infection. The abnormal cells that are observed with conventional or liquid‑based cytologic screening typically appear at a later stage after infection. Lesions that are further advanced may be detected on visual inspection with acetic acid, but the performance of this test is highly variable. The tests used for triage of screen‑positive women are more specific molecular biomarkers of carcinogenesis.
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References

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    1. WHO guideline for screening and treatment of cervical precancer lesions for cervical cancer prevention. Geneva: World Health Organization, 2021. - PubMed
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