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Screening for cancer of the cervix uteri

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Abstract

Cervical cancer is the second most common cancer in women worldwide. The majority of cervical cancers are squamous cell carcinomas. Pap smears for early detection of precursor lesions of cervical cancer have been availáblé for 40 years. A clinical trial to evaluate Pap smears was never undertaken; however, evidence gradually accumulated from time trend analyses and from cohort and case-control studies showed the incidence and mortality of cervical cancer to be reduced by organized screening programs. The risk of cervical cancer following different screening histories was estimated in a recent study of the International Agency for Research on Cáncer. Screening with 1-year and 3-year intervals was estimated to reduce the incidence of squamous cervical cancer by 94% and 91%, respectively. Cervical cancer is rare in young women, and little was estimated to be gained from including women below the age of 25 years in organized screening programs. The age distribution of cervical cancer has changed; a substantial proportion of cases now occur in the older generations of women, who have never been offered organized screening. Computerized pathology registration systems may serve as a tool for integration of the total smear-taking activity and, thus, ensure that a high percentage of women are screened regularly at minimized costs. The planning of a screening program should include both the smear-taking activity and the treatment.

Résumé

Le cancer du col utérin est le deuxième plus fréquent cancer du monde chez la femme. La majorité de ces cancers sont des cancers épidermoïdes. La pratique de frottis pour détecter les lésions précancéreuses du col est connue depuis 40 ans; cependant leur valeur réelle n'a jamais été évaluée avec précision. Les données accumulées à partir des analyses actuarielles, des control-case et des cohortes ont démontré que l'incidence et la mortalité ont pu être réduites par un programme de dépistage. Le risque de présenter un cancer du col malgré ces programmes de dépistage a été estimé par une étude récente. Des examens de dépistage à intervalles de un et de trois ans ont réduit l'incidence du cancer du col de 94% et 91%, respectivement. Le cancer du col est rare chez le femme jeune, et on estime qu'il y a peu à gagner à inclure les femmes de moins de 25 ans dans un programme de dépistage. L'âge moyen auquel ce cancer apparaît a changé: on a vu augmenter la proportion des cancers du col chez la femme âgée qui n'ont jamais bénéficié d'un programme de dépistage. L'informatisation des examens anatomopathologiques pourrait aider à enregistrer des résultats de frottis et à assurer qu'un pourcentage élevé de femmes subit ces examens de façon régulière avec un coût minimum. Dans le programme de dépistage, il faut inclure les résultats de frottis et de traitement.

Resumen

El cáncer cervical es el segundo en frecuencia en las mujeres a escala mundial. La mayoría de los cánceres cervicales son carcinomas escamocelulares. El frotis de Papanicolaou para la detección precoz de lesiones precursoras del cáncer cervical ha estado disponible desde hace 40 años. Jamás se ha emprendido un ensayo clínico para evaluar el frotis de Papanicolaou. Sin embargo, se ha acumulado gradualmente evidencia proveniente de análisis de las tendencias cronologicas y de estudios de cohortes y casos controlados, sobre reducción en la incidencia y mortalidad del cáncer cervical como resultado de programas organizados de tamizaje. El riesgo de desarrollar cáncer cervical en relación a diferentes políticas de tamizaje fue estimado en un reciente estudio de la Agencia Internacional para Investigación en Cáncer. El tamizaje con intervalos de 1 año y 3 años resulta en una reducción estimada de la incidencia de cáncer escamocelular del cervix de 94% y 91%, respectivamente. El cáncer cervical es raro en mujeres jóvenes, y se juzgó que poco se obtiene de incluir mujeres de menos de 25 años en programas organizados de tamizaje. La distribución etárea del cáncer cervical ha cambiado; una proporción sustancial de casos se presenta actualmente en las generaciones mayores de mujeres que nunca recibieron la oferta de tamizaje organizado. Los sistemas computadorizados de registros de patología pueden servir como un instrumento para la integración de los programas de toma de citología, lo cual asegura que un número elevado de mujeres puedan ser tamizadas en forma regular y a bajos costos. El planeamiento de un programa de tamizaje debe incluir tanto la toma de muestras como el tratamiento.

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  1. Danish Cancer Registry, Institute of Cancer Epidemiology, Danish Cancer Society, Landskronagade 66, DK-2100, Copenhagen Ø, Denmark

    Elsebeth Lynge

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  1. Elsebeth Lynge
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Lynge, E. Screening for cancer of the cervix uteri. World J. Surg. 13, 71–78 (1989). https://doi.org/10.1007/BF01671157

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