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Making Programs More Appropriate and Pragmatic

Paul D. Blumenthal, MD, MPH; Lynne Gaffikin, DrPH

JAMA. 2005;294:2225-2228.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Cervical cancer is unique for several reasons. It has recognized, well-described risk factors; there is an identifiable precancerous condition; the transition from precancer to cancer occurs over an extended period (10 years on average)¹; screening tests for detecting cancer and precancer exist; and outpatient treatments for precancer are safe, effective, and relatively inexpensive.

Cervical cancer is also a rare, but confirmed, sequela of a sexually transmitted, high-risk human papillomavirus infection.² Each year almost 500 000 new cases of cervical cancer are diagnosed and 230 000 deaths occur, 80% of which are in low-resource countries.^3-4 Thus, more deaths result from human papillomavirus infection and cervical cancer than from sequelae of all other sexually transmitted infections combined, with the recent exceptions of human immunodeficiency virus (HIV) and AIDS.⁵

Although the Papanicolaou test was developed almost 80 years ago, and cytology-based screening programs were initiated more . . . [Full Text of this Article]

Author Affiliations: Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Md (Dr Blumenthal); and Evaluation and Research Technologies for Health Inc, Oakland, Calif (Dr Gaffikin).

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