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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