What Every Woman Should Know About Cervical Cancer

What Every Woman Should Know about Cervical Cancer Nenad Markovic • Olivera Markovic What Every Woman Should Know about Cervical Cancer Nenad Markovic, M.D., Ph.D Global Academy for Women’s Health Rockville, Maryland USA ISBN 978-1-4020-6936-9 Olivera Markovic, M.D., Ph.D Global Academy for Women’s Health Rockville, Maryland USA e-ISBN 978-1-4020-6937-6 Library of Congress Control Number: 2008925103 © 2008 Springer Science + Business Media B.V. No part of this work may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording or otherwise, without written permission from the Publisher, with the exception of any material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Printed on acid-free paper 9 8 7 6 5 4 3 2 1 springer.com To Our Family In memory of our wonderful parents for raising us to search for truth, their magnificent devotion to the family and their love Our dear children with love and hope they will continue our legacy A Story about This Book and the Authors During the 2006 Annual Meeting of the American Association for Cancer Research (AACR) in Washington DC, we had the pleasure to meet Dr. Cristina Alves dos Santos, Senior Publishing Editor, Cancer Research at Springer, NL. Discussing our work on cervical cancer screening which was presented at the meeting and how we came to our discovery, Dr. Dos Santos suggested that we consider submitting a manuscript to Springer for publishing. In the beginning, we thought it would be interesting to write more about us, our work together as a husband-wife team, how we came to these discoveries and how we proceeded with translational research and brought them from an idea to products. However, this idea, no matter how attractive it seemed, had to be replaced with the actuality of the momentum – the necessity to provide women with a reference book to help them better navigate among new dilemmas and multiple options that modern medicine was offering. What happened between 2006 AACR Meeting and our decision to write the book What Every Woman Should Know About Cervical Cancer? In 2006, the FDA approved the first HPV vaccine (Gardasil by Merck) and raised everybody’s hopes for successful prevention of cervical cancer. It turned the accent from cytological screening to HPV testing, and to the molecular testing – a logical extension to include detecting viral particles. These molecular biology-related ideas called for substantial increase of cervical cancer screening cost, and the funds-sensitive health insurance companies sounded alarm. The first signs of the worst solution appeared when Kaiser Permanente, accepting the new technology, recommended extending the periods between two cytological screenings for cervical cancer. vii viii A Story about This Book and the Authors At that time, we were studying the relation between conventional Pap smear and the newly recommended liquid-based technologies in order to position our biomarker-based test to serve women’s need best. One of the striking results from this study was the conclusion that the frequency of screening (annually) is probably better related to the success of Pap test (reduction of mortality from cervical cancer for 85% in the US), than the testing technology or false readings that has been a widely accepted argument against the Pap test. Recommending to extend the inter-screening periods was an alarming sign signaling to a danger that women could be again insufficiently protected against cervical cancer. More evidence-based information was needed to prevent an unwanted outcome. We decided to use this opportunity and to write a book with emphasis on hea