Vallikad E
Division of Gynaecologic Oncology, St. John's Medical College, Bangalore, India.
Int J Gynaecol Obstet. 2006 Nov;95 Suppl 1:S215-S233. doi: 10.1016/S0020-7292(06)60037-4.
Cancer of the uterine cervix is the commonest gynaecologic cancer in India, with most women presenting with disease extending beyond the cervix. The majority of women belong to the lower socioeconomic status, are rural, aged between 35 and 64 years and highly noncompliant for complete treatment and follow-up. Opportunistic screening with cytology, colposcopy and test for Human Papilloma Virus and appropriate treatment are available on payment at urban private medical centres but are not available at urban and rural government health centres that are accessed by women of the lower socioeconomic status. The Government's investment in health is 0.9% of the GDP. Thus cytology screening as a government health measure is not feasible. The 'social vaccine' of health empowerment along with visual inspection and appropriate referral by the rural and urban health personnel (Department of Health and Family Welfare); with an additional input of health awareness and motivation by Anganwadi Workers (Department of Women and Child Development), elected women representatives in the Panchayats (Department of Rural Development and Panchayati Raj) and non-governmental development agencies could be a collaborative effort towards "downstaging" cervical cancer. This could lay the foundation for the introduction of cytology screening when resources are available.
子宫颈癌是印度最常见的妇科癌症，大多数女性就诊时疾病已超出子宫颈范围。大多数女性社会经济地位较低，居住在农村，年龄在35至64岁之间，且极不配合完整的治疗和随访。在城市私立医疗中心，可付费进行细胞学检查、阴道镜检查、人乳头瘤病毒检测及适当治疗，但社会经济地位较低的女性前往的城乡政府卫生中心无法提供这些服务。政府在卫生方面的投资占国内生产总值的0.9%。因此，将细胞学筛查作为一项政府卫生措施并不可行。通过城乡卫生人员（卫生与家庭福利部）进行健康赋权的“社会疫苗”，同时进行目视检查和适当转诊；由anganwadi工作人员（妇女与儿童发展部）、乡村自治会当选女性代表（农村发展与乡村自治部）和非政府发展机构额外提供健康意识和激励，这可能是朝着使宫颈癌“降期”的方向做出的一项合作努力。这可为在资源可用时引入细胞学筛查奠定基础。
