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Cervical Cancer Screening

Cervical cancer is the second most common cancer, after breast cancer, among young European women aged 15-44. According to IARC estimates for the year 2004, cervical cancer was diagnosed in approximately 34.300 women in the 27 member states of the European Union and about 16.300 women died of cervical cancer.

The social impact of cervical cancer is tremendous, because the majority of cases appear between the ages of 35 and 50, when women are fully active at work and in their families.

Within the EU, wide variation in incidence and mortality is observed. The burden of cervical cancer is particularly high in the new member states: the mortality was highest in Romania (world standardized rate 13.7/100,000 women/year) and Lithuania 10/100.00/year), while in Finland is the lowest (1.1/100,000/ year). The differences can be attributed mainly to the presence or absence of valid cervical cancer screening programs.

Secondary prevention is very important for cervical cancer; in fact among all malignant tumors, cervical cancer is the one that can be most effectively controlled by screening. In industrialized countries, incidence of and mortality from cervical cancer has declined dramatically, most probably as a consequence of cytological screening. According to IARC cytological screening at the population level every three to five years can reduce cervical cancer incidence up to 80%.

Cervical cancer is caused by a virus, the high-risk types of the human papillomavirus (HPV). The primary cause of cervical cancer is a persistent infection of the genital tract by a high-risk type. Genital HPV infections are widespread in the sexually active population; most of these infections clear spontaneously, but when the HPV infection with a high-risk type persists, it can cause changes in cells of cervix epithelium and eventually the cervical cancer.

The factors that determine progression of HPV infection to high-grade cervical lesions and cancer are poorly understood, but cofactors such as decreased immunity are certainly involved.

The cytological abnormalities detected by microscopic examination of Pap smears easily collected, lead to treatment of the precancerous lesions, avoiding the development of invasive cancer.

A cervical cancer screening programme needs the definition of the screening policy:

  • the target age group
  • the screening interval between normal test results
  • the screening test systems,
  • the triage and treatment strategies for screen-positive women.

To obtain the benefits expected an organized screening programme must obtain a high population acceptance and coverage, and must show good quality at every step of the programme:

  • information of the population
  • invitation of the target population
  • collection of the sample
  • performance of the test
  • management of abnormal results
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