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Carcinoma of the Cervix: Entering the 21st Century

 

In developing countries, carcinoma of the cervix (cervical cancer) is the most common malignancy to affect the female population. And, although the mortality rate from this condition has decreased by 50% in the last 30 years, sadly the disease is still widely rampant, accounting for innumerable deaths.

Reducing the burden of cervical cancer therefore remains an important goal for the 21st century, and this is the focus of this 'theme' issue of Obstetrics and Gynaecology Communications.

Reflecting the pivotal aspects of detection, prevention, and treatment, topics covered by articles assembled here include:

  • Cervical screening.
  • Risk factors for cervical cancer.
  • Management of precancerous lesions.
  • Treatment of advanced disease with radiotherapy and/or chemotherapy.


These papers are supplemented by highlights from two recent conferences held in India the XVth Asia Pacific Cancer Conference (Madras) and the 43rd All India Congress of Obstetrics and Gynaecology (Lucknow) both of which had a strong cervical cancer component.

Also included are the first of what is planned as a regular future fixture in theme issues of the Journal feature boxes focusing on various aspects of the subject under discussion (in this case cervical cancer). In compiling these, Obstetrics and Gynaecology Communications would particularly like to acknowledge the information provided by Professor G.K. Rath and Doctors M. Rakshak and S. Chander of the Department of Radiotherapy, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.

The Atlas of Clinical Gynaecology (volume IV, Contemporary Clinical Management of Gynecologic Malignancies) series editor Morton A. Stenchever and published by Appleton & Lange of Philadelphia, USA, was another valuable source of ideas.

 

 

Cervical Screening in Developed Countries

 

Introduction

Significant morbidity and mortality reductions can be achieved through widespread Papanicolaou (Pap) screening for cervical cancer. A successful screening programme requires consideration of local conditions and ongoing evaluation in order to achieve an appropriate and cost-effective strategy. Despite the need for a country-by-country approach to specific procedures, much is to be gained, as always, by reviewing the experience of others. In these papers, kindly reprinted with permission from the Hong Kong Medical Journal, the extensive experience with screening programmes in Europe and the UK is discussed.

 

Key Points

  • Effective cervical screening requires not only a good screening test, but also a good screening programme.

  • Cooperation between clinicians and healthcare planners is essential to achieve effective and feasible screening processes.

  • The most cost-effective way of increasing the impact of cervical screening is to raise the participation rate.

  • A well-planned screening programme minimises the false-positive as well as the false-negative rates.

  • Regular audits of the cervical screening process is required to identify modifications needed.

  • The screening history of all cases of invasive cancer should also be reviewed.

  • Cervical screening has led to reductions in mortality of up to 60% in target populations.

  • New technologies such as liquid-based cytology offer the possibility of further increasing the efficiency of cervical screening programmes.

 

Cervical Screening in Developing Countries

Mitti Hakama (Doctor)

University of Tampere, School of Public Health, Finland

 

Key Points

  • Annual screening of women can reduce the incidence of cervical cancer by 93%, but is an expensive public health measure.

  • Screening once-only at age 45 years offers the best cost-benefit ratio in terms of cost per lives saved and reduces the incidence of cervical cancer by 25%.

  • Screening at age 45 years is a more realistic approach for India, but still involves a target population of 5 million women.

  • A guideline for resource allocation is to divide resources equally between prevention programmes, treatment, and palliative care.

 

Editor's Comment

Programmes in the developed world have provided considerable data on the impact of screening frequency. The author outlines the implications for India and other developing countries.


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