Cervical cytology has proved to be one of the most successful examples of cancer screening and has resulted in significant decreases in incidence and mortality from invasive cervical cancer in regions in which comprehensive programs have been instituted. A standardized system of reporting abnormal cervical cytology, the Bethesda System has been developed and revised to reflect our current understanding of HPV-related precancers. The Pap smear has been the backbone of cervical cancer screening programs in North America over the past five decades; however, recent advances, including liquid-based cytology, HPV typing, and direct visualization techniques, are proposed to address the inherent weaknesses of cytologic screening in women who are screened. The problem of unscreened and underscreened women exists and accounts for most cases of invasive cancer. Widespread screening hopefully one day will lead to a significant decrease in the mortality of cervical cancer, the second most common female malignancy worldwide. Another means of preventing this disease involves HPV vaccines, which are in development but are not ready for use outside of a clinical trial.
