EDITORIALS Old and New Issues in Cervical Cancer Control

Clearly, one of the public health successes of the last 50 years has been the development of an effective approach to cervical cancer control. Dramatic decreases in the incidence of invasive cervical cancer (ICC) have occurred following the establishment of routine cytologic screening and treatment of those lesions (severe dysplasia or carcinoma in situ [CIS]) thought to be im-mediate precursors of ICC. Although it is widely agreed that the aim of cervical cytologic screening should be the identification of all women with these high-grade lesions, there is little agree-ment as to how best to achieve this. Until recently, in many countries such as Canada, physicians primarily relied on cytol-ogy alone to identify women with severe dysplasia/CIS, with referral for colposcopy largely reserved for confirmation of the cytologic diagnosis. However, in the United States, the majority of women with a cytologic diagnosis of mild dysplasia, moder