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Early detection of cervical cancer

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From the Director

Early Detection of Cervical Cancer

SIR

GEORGE ALLEYNE

C

ancer of the uterine cervix can be pre- vented by treatment of precursor le- sions and cured if it is detected in its early stages. Although the technology that allows its early detection has been available for several decades, that capability has not been very successfully applied, from a pub- lic health perspective, in the countries of Latin America and the Caribbean. The mag- nitude of this health problem in the Region demands that the situation be reviewed and that the development of programs be ad- dressed anew.

Mortality from cervical cancer has not fallen in the past 30 years in the countries of Latin America and the Caribbean, and the incidence rates are the highest in the world. In spite of the widespread belief that this type of cancer only strikes older women, 60% of the cases of invasive cervi- cal cancer occur in women between 35 and 60 years of age. However, most cervical cytology examinations are performed on women under 30, whose cancer risk is low. The result is that unnecessary treatment is given for many lesions that experience has shown would very probably not progress to malignancy. Thus, screening activities are being directed at a large group of women at very low risk and therefore are not hav- ing the desired impact.

One of the most important factors in early detection programs is the rational use of available resources. What is needed is not necessarily to formulate new programs, but rather to give them a more appropriate di-

rection. With the same resources, it is pos- sible to reorient cervical cytology testing toward the age group at highest risk and to establish testing intervals that make the program cost effective. In this way, the pri- mary care services will not be overbur- dened with new functions and the response capacity of the secondary and tertiary lev- els will be focused on the women who re- ally need those services.

Another need, in addition to that of ra- tionalizing health services, is to find out what women think of the program and en- courage their participation in its various aspects. This effort requires not only exten- sion of coverage but also follow-up of us- ers, programming of diagnostic and treat- ment activities, and support for those activities. A better understanding of the problem and the response of society as a whole is essential in order to overcome ad- ministrative, social, and cultural barriers that currently limit women’s access to early detection programs.

The Noncommunicable Diseases Pro- gram, Division of Disease Prevention and Control of the Pan American Health Orga- nization, believes that the development of early detection programs for cancer of the uterine cervix is a pivotal activity that will permit a comprehensive approach to the problem of chronic diseases in general and women’s health in particular. Cervical can- cer is the fourth leading cause of death in women 15-64 years of age in Latin America and the Caribbean. The early detection pro-

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gram for this type of cancer offers a spe- cific intervention that has become familiar to women during their contact with the re- productive health services. It is not only a point of entry to improve their access to health services but also represents an op- portunity to prevent and manage other health problems, such as cerebrovascular accidents, acute myocardial infarction, and

diabetes mellitus-afflictions which oc- cupy the first three places as causes of death of women in this age group.

In light of all of the above, the emphasis being placed on the early detection of cer- vical cancer is not merely fortuitous. Rather, such a program is an essential component of a broader strategy aimed at achieving health for all and by all.

Acknowledgment

The Editorial Service would like to thank Dr. Sylvia C. Robles, Regional Adviser, Non-Communicable Diseases Program, Pan American Health Organization, for her fine contribution as the guest editor and technical reviewer of this special issue.

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