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Preface by the ASC President
The cervical/vaginal Papanicolaou smear has been tremendously successful
in reducing the death rate from cervical cancer. The success of screening
has been demonstrated most convincingly in countries with formal cytology
screening programs with wide population coverage. These countries have
experienced substantial drops in incidence and mortality from cervical
cancer, while other countries with limited or no population screening
have not. The accessibility of the cervix to direct examination and the
relatively slow progression to cervical cancer from recognized and treatable
precursor lesions make cervical neoplasia an ideal target for screening
and prevention efforts.
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In many developing countries, however, screening
is available to only a small segment of the population through urban clinics
or hospitals, or not at all. Obstacles to comprehensive cervical cancer
screening include: lack of public and clinician awareness of cervical cancer
as a health problem, lack of awareness of the benefits of screening, inadequate
numbers of trained clinicians, inadequate supplies, inadequate laboratory
facilities and personnel to evaluate specimens, loss to follow-up and inadequate
treatment facilities. For many countries, comprehensive cytologic screening
performed at regular intervals is unattainable at the present. Other approaches
to screening must be considered, such as limiting the age range for screening
and/or a combination of cytologic and noncytologic approaches to screening
that do not require an extensive infrastructure of trained personnel.
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Recently, interest has focused on development
of technologies to enhance the accuracy of cervical cancer screening. Some
of these techniques are directed at improving sampling and specimen quality,
others are focused on improving the laboratory microscopic screening process,
and yet others are visual or molecular rather than microscopically based.
Many of these new technologies may appear to be well beyond the financial
capabilities of developing countries that are seeking to establish or improve
existing screening programs. However, using cost-effectiveness analyses,
one might develop a screening strategy with one or a combination of screening
techniques, resulting in improved sensitivity; theoretically, the gain in
sensitivity may allow less-frequent screening, thus possibly reducing overall
screening costs. Our goal must be to reduce the incidence of cervical cancer
for as many women as possible, given the reality of the funds and infrastructure
available.
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Diane Solomon, M.D., M.I.A.C.
President, American Society of Cytopathology
Senior Investigator, National Cancer Institute
National Institutes of Health
Project Officer, ALTS Project
Rockville, Maryland, USA |