A detailed guide to the many factors that need to be considered when planning and managing a screening programme for the early detection of cervical cancer. Noting that screening programmes often fail to have an ipact on incidence rates and mortality, the book concentrates on key managerial decisions, such as the definition of target groups and the frequency of screening, that will determine a programmes capacity to detect cervical cancer at an early, curable stage in the population at greatest risk. Advice and recommendations draw upon evidence from several large investigations as well as experiences with different programmes throughout the world. Policies that consume resources without improving results are clearly indicated. The book has six chapters. The first explains the importance of establishing cervical cancer screening programmes within the context of a national programme for cancer control. Four basic steps in the formulation of a national cancer control policy are identified and discussed as they relate to requirements for the control of cervical cancer. The chapter also describes several simple methods that can be used to gather data and support well-informed decisions. The second chapter reviews current knowledge about the natural history of cervical cancer in terms of its implications for screening policy. Readers are informed that the most important risk factor is age, that programmes should concentrate on women aged 35 years and older, that screening of younger women can lead to useless overtreatment, and that annual screening is totally unnecessary. The third chapter sets out managerial guidelines for the implementation and evaluation of screening programmes. Concentrating on key managerial decisions, the chapter considers such questions as when a screening programme can be implemented, which sector of the health service should be used as the organizational base, and who should be responsible for management, surveillance, and evaluation. Concerning selection of the most appropriate service sector, the chapter considers the pros and cons of using maternal, child health and family planning services, occupational health services, and mobile screening units. Other chapters offer advice on the organization of screening programmes in the context of primary health care, and outline programme requirements in terms of information systems. The final chapter presents the concept of downstaging as an interim measure that might reduce mortality from cervical cancer in countries lacking the facilities and resources required for population-wide screening. Noting the high proportion of cases diagnosed at an advanced stage in these countries, the chapter explains how downstaging, which involves the use of a simple speculum for visual inspection of the cervix, might result in detection of cervical cancer at an earlier stage when treatment is still possible.

DC.HQ

chi eng fre rus spa.

WHODOC

WHO monograph

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