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  • Title: Cervical cancer control in developing countries: memorandum from a WHO meeting.
    Journal: Bull World Health Organ; 1996; 74(4):345-51. PubMed ID: 8823955.
    Abstract:
    This memorandum summarizes the report of a WHO Consultation on the Control of Cervical Cancer in Developing Countries, held on 6-7 November 1994, in New Delhi, India. Evaluated was the current situation with regard to cervical cancer and the relevance of current practices in screening. New pragmatic approaches to cervical cancer were proposed that are relevant for developing countries; this includes empowerment of women to come forward, and visual inspection-"downstaging". This memorandum summarizes the report of a World Health Organization (WHO) Consultation on the Control of Cervical Cancer in Developing Countries held in November 1994 in New Delhi, India. The WHO international study group analyzes and evaluates the feasibility and validity of various low-cost strategies for cervical cancer screening in low resource settings compared with cytology (i.e., Pap smear). It focuses on the effect of health education and empowerment of women and the effect of the clinical downstaging approach (i.e., simple visual inspection of the cervix of asymptomatic women). The group agreed on a model protocol for a controlled randomized study designed to evaluate the applicability and cost-effectiveness of different approaches to the early detection of cervical cancer in developing countries. The protocol consists of four study arms: control group, health education only group, health education and visual inspection, and health education and Pap smears. The participants analyzed experiences from the UK, South Africa (Cape Town and Orange Free State), India (Delhi and Bangalore), and Nordic countries (Sweden and Finland). They also examined prospective studies on cervical cancer screening in Zimbabwe, the UK, India, Bangladesh, Philippines, Brazil, and Malaysia. Clinicians and public health officials need to recognize cervical cancer as a major but soluble health problem among women in most developing countries. Health education about cervical cancer, its signs and symptoms, and its curability as well as health education about their own reproductive health could empower women and therefore have a major impact. Availability of standard therapy and appropriate management and effective early detection and referral policies are needed to minimize morbidity and mortality from cervical cancer. Researchers need to conduct controlled studies to examine ways that are most effective in empowering women. Visual inspection and quality controlled cytology screening should be evaluated. Early detection and other clinical aspects should be done simultaneously.
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