Progress in screening for cervical cancer
Online posting: Sept. 12, 1996
Published in print: Oct. 15, 1996 (CMAJ 1996;155:1037)
Re: Why is there no progress against cervical cancer?, by Dr. Marsha
M. Cohen, CMAJ 1996;154:1867-9 [full text / résumé]
Dr. Marsha M. Cohen is to be commended for her insightful and
provocative editorial. She identifies three prominent issues:
priority and advocacy, professional issues and the complexity of
the task. Although there is a need for "healthy scepticism,"
positive actions being taken in each of these areas may mitigate
the gloomy picture Cohen describes.
Screening for cervical cancer has lacked strong advocacy and
high-priority status on the women's health agenda as a result of
the stigma of abnormal results of Papanicolaou smears and of
sexually transmitted diseases. However, this situation is
changing. Cervical cancer screening was addressed at the
Canada–US Women's Health Forum in August. The Canadian Cancer
Society and National Cancer Institute of Canada have developed
strategies for increased public awareness. Since 1976, Nova
Scotia, Prince Edward Island, Ontario, Manitoba, Alberta and
British Columbia have all developed or implemented critical
components of a comprehensive program.
Professional issues have hindered implementation of coordinated
screening programs in the past. However, the Canadian Society of
Cytology will release this year an updated national consensus
document on quality assurance guidelines for cytopathologists.
The Society of Obstetricians and Gynaecologists of Canada has
coordinated strategies for training, including obtaining adequate
smears and following up abnormal results. National guidelines for
colposcopy are available through the Canadian Society of
Colposcopists, and guidelines for management of invasive cancer
of the cervix have been published by the Society of Gynecologic
Oncologists of Canada. Such national guidelines have gone far
toward resolving the professional issues at a provincial level.
The complexity of prevention has been greatly reduced by the
Cervical Cancer Prevention Network, a cooperative effort of
federal, provincial and territorial representatives, supported by
the Disease Prevention Division at Health Canada. This network
facilitates the sharing of information and expertise on
recruitment strategies, information systems, program management
and evaluation. This information sharing has included national
specialty societies, consumers, provincial administrators and
analysts.
Coordination through a national network will help maintain the
scope of preventive programs, minimize duplication of effort and
allow implementation in a provincial or territorial contxIf
the decrease in the mortality and incidence of this type of
cancer since 1969 continues, cervical cancer will no longer need
to be a high-priority issue for the health of women in Canada.
Gavin C.E. Stuart, MD
Coordinator
Cervical Cancer Prevention Network
Director
Tom Baker Cancer Centre
Southern Alberta Cancer Centre Program
Calgary, Alta.
Gary V. Krepart, MD
President
Society of Obstetricians and Gynaecologists of Canada
Pierre Drouin, MD
President
Society of Gynecologic Oncologists of Canada
Maria Paraskevas, MD
Chair
Canadian Society of Cytopathology
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