Use of screening for cervical cancer

Cervical cancer screening started with the introduction of the Papanicolaou test into clinical practice. In many countries, this occurred as part of family-planning services, so that the target group was younger women. Because such services are frequently not well integrated with secondary levels of care, it was not always possible to ensure adequate diagnosis and treatment of women with a positive test result. It has now become clear that organized screening programmes have a greater impact than opportunistic screening because they have the potential to achieve greater participation and this can improve equity of access and the likelihood of reaching women at higher risk. Cervical cancer screening comprises various types of care or services, ranging from provision of the screening test to diagnosis and treatment, as shown in Figure 46. Implementation of a national programme requires that there be a national policy that defines the screening age and interval and what method of screening will be used, as well as sufficient political and financial investment. The major issues that have to be considered are: • The budget to run the programme • Training of health-care providers in: the logic of the screening policy; carrying out the screening test; patient counselling; and collection and interpretation of monitoring data (participation and follow-up rates) • Setting up equipment supply systems for the clinic or health centre • Ensuring that high-quality laboratory services are available • Establishing a referral pathway for treatment of patients (which may involve training of people at local level and referral for more advanced cases needing specialized treatment) • Developing the capacity to offer treatment (for in situ disease, definitive treatment and palliative care) • Setting up national monitoring systems • Education of the population to ensure participation in the screening programme Overall, a screening programme should be an integrated system in which, as seamlessly as possible, women are recruited, screened, receive and understand the results, are referred for treatment as required, return for repeat screening as determined by the policy and become advocates for others to participate. This means that all staff must know, understand and give the same message to patients, that services be accessible, equipped and welcoming, and that transport and communications mechanisms with institutions for reading of results and treatment are functional. In other words, a functional health system must operate with sufficient coverage, so that all women in the target group have satisfactory access to services. The organization and financing of the overall health-care system of a Delivery and uptake of screening