Cervical cancer at the crossroads : an historical ontology of evidence in cervical cancer prevention

This thesis interrogates the clinical, epistemological and ontological implications of complex changes in the practices of cervical cancer prevention. Since the post-war period, women throughout most western countries have undergone cytology-based screening to detect and treat cellular changes before they turn to cancer. Over the past decades, the recognition of the causal role of Human Papillomavirus (HPV) in cervical cancer has prompted shifts in policies and practices, with new HPV vaccines and tests being gradually introduced into health services worldwide. Empirically, this thesis is based on archival research and qualitative interviews with cervical cancer experts. By analysing these sources via methods and theory from medical sociology, history and philosophy of science, and Science and Technology Studies, the thesis has three findings. First, it demonstrates that we are witnessing a change in the nature of the constitution of cervical cancer. New HPV-based interventions are changing the practices of cervical cancer prevention and, thus, creating paradigmatic changes in its ontological constitution. Cervical cancer emerges as the material outcome of a historical process of hybridisation, hierarchisation and singularisation of the multiple, variable and occasionally contradictory realities of HPV infections, cervical carcinogenesis and women's bodies. Second, it demonstrates a method of 'historical ontological politics' that can capture and critique the materialisation of care and disease, by interrogating the normative capacity of statistical ways of knowing and doing in science and medicine. Finally, this thesis articulates the value of 'black swan' irregularities for understanding and improving cervical cancer prevention.