The Natural History of Cervical Cancer

Interest in the natural history of cancer of the cervix began with the recognition that for effective and efficient application of screening, “the natural history of the disease should be known” (Wilson and Junger, 1968). This is because screening is based on the expectation that the early detection of cancer, in what has been called the Detectable Preclinical Phase (DPCP) (Cole and Morrison, 1980), will result in a reduction in mortality from the disease. If effective screening is directed primarily to the detection of precursors, the development of invasive cancer will be prevented. Therefore, an effective program for screening for cancer of the cervix will result in a reduction in cancer incidence as well as a reduction in cancer mortality. Knowledge of the natural history of the disease will facilitate decisions on the appropriate ages to initiate and cease screening, and the optimal frequency of re-screening in those who test negative.