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The WHO has previously produced recommendations on the essential drugs required for cancer therapy. Over the last five years several new anti cancer drugs have been aggressively marketed. Most of these are costly and produce only limited benefits. We have divided currently available anti-cancer drugs into three priority groups. Curable cancers and those cancers where the cost-benefit ratio clearly favours drug treatment can be managed appropriately with regimens based on only 17 drugs. All of these are available, at relatively low cost, as generic preparations. The wide availability of these drugs should be the first priority. The second group of drugs may have some advantages in certain clinical situations. Based on current evidence, drugs in the third group are judged as currently not essential for the effective delivery of cancer care. Adequate supportive care programmes with the widespread availability of effective drugs for pain control are of considerably greater importance. The adoption of these priorities will help to optimise the effectiveness and efficiency of chemotherapy and ensure equitable access to essential drugs especially in low resource environments. Clearly this paper represents the views of its contributors. The WHO welcomes feedback from all oncologists so that the advice it gives to governments in prioritising the procurement of anti cancer drugs can be as comprehensive as possible.

The greatest decrease in breast cancer mortality is likely to derive from applying globally existing therapies at an earlier stage. A high priority of the World Health Organization (WHO) cancer control program is the outreach approach that promotes worldwide access to cancer therapies of proven values. Therefore, the first priority in national health programs for breast cancer is to encourage patients to present for diagnosis and treatment at an earlier stage of the disease. In the development of guidelines for the early detection of breast cancer, the WHO emphasizes the importance of appropriate widespread coverage of high‐risk groups as opposed to repetitive screening of low‐risk groups, so that early detection will be effective. A WHO/USSR controlled trial of breast self‐examination and community‐based adjuvant therapy is helping to develop the WHO global recommendations for the control of breast cancer. Depending on the extent of the breast cancer problem, the local resources, and the cultural situation, national health strategies should include all three main elements—public education, early detection, locally available treatment, or a combination of these to a national comprehensive program for the control of breast cancer.

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During the present meeting, the participants reviewed the state of the art on screening for cervical cancer, and considered a number of promising new developments. Four key areas comprised a major focus of the discussions, programmatic issues, cervical cytology, alternative methods of screening and diagnosis and treatment of dysplasia.Worldwide, cervical cancer comprises approximately 12% of all cancers in women. It is the 2nd most common cancer in women worldwide and the most common in developing countries. The global estimates are for 452,000 new cases and more than 234,000 deaths from cervical cancer each year around 2000 (Ferlay et al., 1998;Parkin et al., 1999). Eighty percent of these cases are found in developing countries with only 5% of global cancer resources.Cervical cancer is both preventable and curable. Widespread comprehensive cervical cancer control programs have helped some developed countries to achieve up to an 80% reduction in incidence and mortality from cervical cancer. In developing countries, 60 -80% of cases are seen in advanced stages (III and IV), if ever diagnosed, with a low probability of long-term survival (Sankaranarayanan et al., 1998a).In most developing countries, cytological screening is not currently available for population-based screening programs, and will not be possible for several decades. In a few countries where it is available, it is of suboptimal quality. Several studies are being conducted worldwide to evaluate alternative, feasible techniques for cervical cancer in comparison to cytology. Consideration of these studies comprised one of the main features of this consensus conference.The participants considered cervical screening projects and programs from Brazil, Chile, Finland, India, Iran, South Africa, Sri Lanka, Tunisia and Zimbabwe. These programs are in highly varied stages of evolution (from pilot studies to highly successful nationwide efforts) from areas of the world with major differences in incidence rates of cervical cancer and varied levels of economic development.The program in Finland is the model for organized programs of screening by cervical cytology worldwide. This program began in 1960 with 5 yearly screening for women age 30 to 59, invited through the national population register (Hakama and Louhivuori, 1988). Considerable attention was devoted to education of the population, fast feedback of screening results to women, a costeffective system for referral of women with abnormalities, histological confirmation of diagnoses and continuous quality control (Syrjänen, 1995;Hristova and Hakama, 1997). Recent data show much greater efficacy following smears conducted in the organized program than opportunistic smears.The programs under development in Tunisia and Iran illustrate the relatively low risk of cervical cancer in Islamic populations. Nevertheless, in Tunisia, cervical cancer is the second most com-