Report on consensus conference on cervical cancer screening and management A meeting of the International Network on Control of Gynaecological Cancers (INCGC) was held in Tunis, January 28–31, 1999. This was a follow-up to a World Health Organization (WHO) Consultation on the Control of Cervical Cancer In Developing Countries held in 1994 at which the Network had been formed (Memorandum, 1996). The principal objectives of the Network are to create strategic collaboration between different international ins

Abstract

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-