Prospects for the primary and secondary prevention of cervical cancer

This thesis is written at a time when despite a continuing decline in the age standardised mortality from cancer of the cervix there has been a reported increase in mortality in young women, a growing dissatisfaction amongst clinicians with respect to the number of women referred for colposcopic investigation and treatment and an awareness that much of this activity is inefficient in terms of cervical cancer prevention. There is increasing recognition of the imperative to channel those resources available for the primary and secondary prevention of the disease in a more efficient manner. At the same time the candidacy of Human papillomavirus as an aetiological agent in cervical neoplasia has been widely touted. Enthusiasm for an oncogenic role for this virus has been based largely on the association of this virus with various degrees of cytological and histological cervical abnormality and on growing experimental evidence of its oncogenic potential. This thesis will address these two areas of concern. It will attempt to determine whether operational policies with respect to screening and colposcopic referral can be improved in a group of young women. Secondly, it will also inform the debate concerning the aetiological role of human papillomavirus by providing a detailed descriptive account of the molecular epidemiology of this infection. It will also discuss the development of the use of the polymerase chain reaction as a sensitive detection method for viral infection and the difficulties encountered with its use