Screening Tests, Policies, and Programs. Cervical cancer is easily detected before the disease becomes symptomatic via screening programs. The primary screening test for cervical cancer, the Papanicolaou Test, often referred to as the “Pap test,” or “Pap Smear,” has contributed greatly to the precipitous decline in cervical cancer mortality which occurred during the latter half of the twentieth century. From 1946 to 2000, the US age-standardized cervical cancer mortality rate is estimated to have declined by 76%, primarily due to the introduction of the Pap test in 1941.25 A Pap test is a procedure employed to collect cervical cells for cytology testing, or examination of cells under a microscope to diagnose cancers and/or pre-cancers. During a Pap test, a small spatula is used to scrape a sample of cells and mucus from the surface of the cervix nearest the vagina. Thereafter, a small brush or cotton swab collects samples from the endocervix (the portion of the cervix nearest to the uterus). Lastly, the collected samples are prepared for microscopic examination through two primary methods, including: placement of the smear samples directly onto a glass microscopic slide prior to laboratory testing (referred to as “Conventional Cytology”), or suspension of the smear sample in a special preservative liquid prior to laboratory testing under microscope (termed “Liquid- based Cytology,” or a liquid-based Pap test).2 Pap test screening is universally recommended as the primary means to detect cervical cancer by the three preeminent U.S.-based public health organizations that standardized nationwide cervical cancer screening guidelines in 2003. These three organizations, American Cancer Society (ACS), the American College of Obstetricians and Gynecologists, and the United States Preventive Services Task Force (USPSTF), collectively recommend that cervical screening begin 3 years after sexual debut, but no later than age 21. The point of contention between these three organizations concerns the frequency and discontinuation of cervical cancer screening. The USPSTF recommends that women be screened on at least a triennial basis. The ACS and the ACOG, meanwhile, recommend that women less than 30 years old be screened on an annual basis if a conventional Pap test is used; the ACS extends this screening interval to a biennial basis if a liquid-based Pap test is used. For women older than 30, both the ACS and the ACOG propose that screening may occur on a biennial or triennial basis if a woman has three conse...
