Overview

Cervical cancer is the second most common cancer among women worldwide, with almost half a million new cases each year. Almost 80 per cent of the women affected are in the developing world. Yet many of these cases could be prevented from progressing to invasive disease, and potentially death. More so than any other cancer, cervical cancer is a disease which lends itself to early detection and treatment. The effectiveness of cytology screening as a method to reduce the number of invasive cases and deaths resulting from cervical cancer in developed countries has already been demonstrated. Alternative screening tests, such as VIA and HPV testing are currently being examined and may prove feasible in the near future. Policy makers and clinicians are faced with the responsibility of establishing and reviewing screening programmes that have the potential to save the lives of many millions of women each year. This report offers a summary of the evidence on which to base important decisions. It focuses particularly on the situation in low and middle income countries - countries in which cervical cytology screening may not be feasible or cost effective. It documents the current state of evidence concerning alternative tests - Visual inspection with Acetic acid (VIA) and Human Papillomavirus (HPV) testing. It reviews trials that are currently being undertaken, and gives policy makers an indication of developments that are likely to emerge in the near future. However, it also emphasizes that the efficient and effective functioning of the system in its entirety is central to the success of any screening programme, irrespective of the screening method chosen. This publication is the product of a comprehensive consultation undertaken by WHO in 2001, involving leading experts in the field of cancer epidemiology, screening and treatment. It is part of WHO's commitment to provide evidence-based guidelines to decision makers and a recognition of the priority that should be given to cervical cancer screening and treatment as an essential component of any comprehensive national cancer control programme.

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