CMAJ Readers' Forum

Progress in screening for cervical cancer

Online posting: Sept. 12, 1996
Published in print: Oct. 15, 1996 (CMAJ 1996;155:1036)
Re: Why is there no progress against cervical cancer?, by Dr. Marsha M. Cohen, CMAJ 1996;154:1867-9 [full text / résumé]
In Ontario, progress has certainly been made in improving screening for cervical cancer. This confirms that it is never "too late," as Dr. Marsha M. Cohen states in her editorial.

In 1993, concern about the steady incidence and mortality rates from cervical cancer in the last 10 years led to the formation of the Ontario Cervical Screening Collaborative Group (OCSCG) by the Ontario Medical Association, the Ontario Association of Medical Laboratories and the Ontario Cancer Treatment and Research Foundation. Many other organizations, professional societies, community representatives and the Ontario Ministry of Health are now members. The goal of the OCSCG is to reduce the incidence and mortality rates from this preventable cancer by 50% by the year 2005.

The plan for a comprehensive screening program builds on the existing system in Ontario. To date, the member organizations have approved Ontario-specific guidelines for screening women with previous normal results of Papanicolaou smears. Uniform terms for reporting the results of smears have been endorsed. Methods to improve the taking of Papanicolaou tests are being finalized. Recommendations for the follow-up and management of women with abnormal results of smears are being prepared. These guidelines and recommendations will be disseminated to all physicians in the fall of 1996. Efforts are being planned to encourage women who have never had a Papanicolaou test or have rarely been screened to have a test. These initiatives require the support of a cervical screening registry.

Six private medical diagnostic laboratories, which together process 60% of all Papanicolaou tests in Ontario, have formed the not-for-profit organization Inscyte. Inscyte has launched an electronic, centralized cytology database, which uses the provincial standard terms. In pilot projects being conducted in Middlesex County and Thunder Bay records of all Papanicolaou tests are being linked with records of relevant colposcopic and histopathologic tests.

How has Ontario has overcome the barriers Cohen identifies? The Ontario government has identified screening for cervical cancer has been identified as a priority. Women from the community are members of the OCSCG. Turf wars and medical minutiae have been reduced through collaboration in a joint public- and private- sector group whose members report back to their respective organizations. Perhaps this approach to changes in health care can be applied to other areas.

Progress is being made. Much is still to be done, but it is never "too late" to begin.

E. Aileen Clarke, MB, MSc, FRCPC
Chair
Ontario Cervical Screening Collaborative Group
Toronto, Ont.
aileen_clarke@octrf.on.ca


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