Pimple Sharmila A, Mishra Gauravi A
Department of Preventive Oncology, Tata Memorial Center, Mumbai, India -
Department of Preventive Oncology, Tata Memorial Center, Mumbai, India.
Minerva Ginecol. 2019 Aug;71(4):313-320. doi: 10.23736/S0026-4784.19.04397-1. Epub 2019 Feb 22.
Cervical cancer is highly preventable and can be easily treated if detected at early stages. However there is disproportionate high burden of cervical cancer incidence and mortality in low-middle income (LMIC) country settings that lack organized screening and prevention programs. Robust evidence for prevention and screening of cervical cancer is currently available. However there are barriers for country specific adoption and implementation. These pose unique challenges such as organizing prevention and screening services delivery through the current health infrastructure, access to screening facilities, follow-up management and adequate linkages for confirmatory diagnosis and subsequent treatment. Overall cervical cancer screening rates and cancer screening among women still remains suboptimal in many LMIC's. Considering the complexities involved in organization, service uptake and delivery of population based cervical cancer prevention and screening programs, this article aims to provide evidence based appropriate, affordable and effective standardized cervical cancer prevention and screening guidelines that are operationally feasible to help adopt best practices for uniform adaptation and implementation leveraging with the existing public health care settings. Cost-effective strategies and tools to reduce cervical cancer burden worldwide to mitigate the existing disparities in cervical cancer burden between low-resourced and high-resourced settings are needed. The current cervical cancer prevention and screening guidelines are drawn from the most robust evidence generated from the randomised trials and cross-sectional studies undertaken in the socioeconomic, cultural and health systems context of varied geographic settings and therefore conform towards applicability for wide-scale, sustainable and uniform implementation of population based cervical cancer screening and prevention program.
宫颈癌是高度可预防的,如果在早期被发现,也很容易治疗。然而,在缺乏有组织的筛查和预防项目的中低收入国家,宫颈癌的发病率和死亡率负担却异常沉重。目前已有关于宫颈癌预防和筛查的有力证据。然而,在各国具体采用和实施方面存在障碍。这些障碍带来了独特的挑战,比如如何通过现有的卫生基础设施组织预防和筛查服务的提供、如何获得筛查设施、后续管理以及为确诊和后续治疗建立充分的联系。总体而言,在许多中低收入国家,宫颈癌筛查率以及女性癌症筛查率仍然不尽如人意。考虑到基于人群的宫颈癌预防和筛查项目在组织、服务接受和提供方面的复杂性,本文旨在提供基于证据的适当、可负担且有效的标准化宫颈癌预防和筛查指南,这些指南在操作上可行,有助于采用最佳实践,以便在现有公共卫生保健环境下进行统一调整和实施。需要具有成本效益的策略和工具来减轻全球宫颈癌负担,以缩小资源匮乏地区和资源丰富地区在宫颈癌负担方面现有的差距。当前的宫颈癌预防和筛查指南借鉴了在不同地理环境的社会经济、文化和卫生系统背景下进行的随机试验和横断面研究得出的最有力证据,因此符合大规模、可持续且统一实施基于人群的宫颈癌筛查和预防项目的适用性要求。