Organization of screening programs in developing countries with reference to screening for cancer of the uterine cervix in India.

Cancer of the uterine cervix is the leading female malignancy in developing countries such as India. Efforts for early detection by cervical cytology smears have been few, restricted to special situations, or short-term. No measurement of impact in terms of decline in mortality or incidence rates has been possible in India. However, a study by the Cytology Research Centre, New Delhi, on the natural history and biological behaviour of dysplasias provides evidence of the usefulness of screening to detect malignancy at early stages; both routine follow-up by cervical smears of women with dysplasia as well as screening of women attending gynaecological out-patient departments were used. This paper reviews the magnitude of the problem of uterine cervical cancer, the epidemiological aspects of the present situation in India, the efforts made for its control in different parts of the country and the problems encountered in organizing cervical cancer screening programs. Models of the approaches adopted are described, and guidelines are suggested which include the utilization of several approaches, including institution-based programs, extension of services to peripheral areas through mobile units, links with maternal care services, and establishment of referral systems. The need to develop human resources in cytology, in both medical and paramedical categories, is highlighted.