Screening for cervical cancer: when theory meets reality

Cervical cancer prevention activities need to be monitored and evaluated in each country where they are introduced to see that they meet performance standards. Policy-makers responsible for allocating resources for cervical cancer prevention have a duty to allocate resources not only for cervical cancer screening, but also for screening program surveillance.In the medical field, disease prevention is often considered a cost-effective alternative to treatment. This statement is especially true for cervical cancer, where late-stage treatment is expensive and the outcome generally poor. Indeed, in Norway the 5-year relative survival rate for patients with late-stage cancer at the time of diagnosis has remained largely unchanged since 1956, hovering around 10%. In contrast, the same figure is over 90% for patients with stage I cancer [1]. Through screening individuals with asymptomatic preinvasive lesions are identified and treated to halt the process of cancer development. These findings imply that early diagnosis and treatment of cervical disease comprise a powerful strategy to combat the morbidity and mortality associated with cervical cancer. Unfortunately, implementation of these strategies in some parts of the world is not always feasible, and recently the International Agency for Research on Cancer reported that cervical cancer is still the second most common cancer worldwide, and disproportionately affects low-to-medium-income countries [2].There is no doubt that cervical cancer screening reduces the morbidity and mortality due to cervical cancer. In order to determine which screening model would maximize health benefits within a given set of limited resources, decision makers often use cost-effectiveness models. During the last decade, results from mathematical modeling studies have become increasingly important in policy-making discussions on whether to implement human papillomavirus (HPV) vaccination and/or cervical cancer screening, as well as in the discuss