Public Health Advances in Cervical Cancer Prevention
More than 30 years of epidemiologic research by DCEG investigators has helped to establish the central causal role of carcinogenic genotypes of human papillomavirus (HPV) in the development of virtually all cases of cervical cancer. NCI’s natural history studies have shown that it is persistent HPV infection, and not the infection itself, that increases the risk of developing cervical cancer. This finding led to the creation and adoption of screening and clinical management guidelines by numerous organizations: the American Cancer Society, ASCCP, the Association of Clinical Obstetricians and Gynecologists, and the World Health Organization.
Primary Prevention through HPV Vaccination
NCI scientists invented the virus-like particle technology that enabled the development of HPV vaccines to prevent infection and resultant cancer. An NCI-sponsored Phase III clinical trial to evaluate the efficacy of a vaccine against HPV types 16 and 18 showed near-complete protection against new infections and precancerous lesions. As a result, the U.S. strategy for the prevention of cervical cancer has been transformed from reliance on untargeted, frequent, and lifelong repetition of Pap smears to a combination of vaccination and targeted HPV-based screening.
Learn more about DCEG research on HPV and other infectious agents.
Secondary Prevention through Screening and Clinical Management
DCEG investigators developed and validated HPV DNA testing that directly assays the causal virus. Now in widespread use in the U.S., the test provides greater accuracy than ambiguous Pap tests and has led to improved clinical management strategies, with lengthened screening intervals.
In 2020-2021, new guidelines for screening and clinical management of cervical precancer from the American Cancer Society, a U.S. consensus committee, and the World Health Organization, are based on research by DCEG investigators.
The 2019 ASCCP Risk-Based Management Consensus Guidelines are presented in a series of eight papers in the Journal of Lower Genital Tract Diseases and are available free on the web and as a downloadable application for smartphones.
These guidelines utilize a risk-based approach and focus on HPV testing for primary screening. Paired with vaccination against HPV, they support the global effort to accelerate cervical cancer control.