Epidemiology and detection of cervical cancer. Implementing the national screening policy.

The epidemiological bases of primary prevention and early detection of cancer of the uterine cervix are presented with emphasis on recent developments that are important for clinical practice. The progress of the implementation of the Australian cervical cancer screening policy is also discussed. A Medline search on cervical cancer, 1991-1996, was supplemented by material from international and local authorities, including reports on all aspects of cervical screening in Australia. National and international patterns of risk factors, predictors of progression and regression of precancerous lesions, cervical cancer incidence and mortality are summarised, with emphasis on the most recent and local research. Human papilloma virus (HPV) types are important causes of cervical intra-epithelial neoplasia (CIN) and squamous cell carcinoma. Most cervical screening is performed during medical consultations; additional financial incentives to promote correct targeting of this screening test should be explored. The Commonwealth Government is developing a national policy for the training of persons to provide cervical screening to supplement that provided by medical practitioners. The improvements in the national application of cervical screening should continue with the development of quality assurance at all stages of the screening pathway.