Screening. The next century

BACKGROUND: Screening for cervical cancer and its precursors has traditionally been performed by Papanicolaou smear. As cost considerations have become more important and as developing countries have begun to initiate screening programs, other approaches to screening have been considered. METHODS: Proposed new methods potentially useful for screening for cervical cancer and its precursors were reviewed. RESULTS: Cervical cancer screening using unaided or aided visual approaches, human papillomavirus DNA testing and typing, cervical photography, and automated Pap smear screening instruments are all potentially valuable when used alone or in combination, depending on the country. CONCLUSIONS: New techniques will make it possible to screen high risk, low-income populations for cervical cancer and its precursors and to do so more cost-effectively than is possible using conventional Western approaches. In addition, the latest technology can enhance the screening methods traditionally used in industrialized countries and can increase the positive and negative predictive value of the screening method.