Screening for cancer of the cervix. Program of the Central Region of Portugal.

Abstract

Cervical cancer screening is clearly efficient, as can be proved by a simple comparison of the incidence and mortality rates for this neoplasia before and after the implementation of screening programmes in various countries and regions. The Screening Programme of the Central Region of Portugal is done by the G.P., who collects cytological smears in the Health Centres and sends them to the Cytopathology Laboratory of the Coimbra Cancer Institute (IPO). The IPO not only does the cytological test but also coordinates the programme and is responsible for quality control. To date, 83,173 women have been screened. Although the average participation rate is low (34.5%) some Health Centres have a very high rate, above 90%. The detection rate of pre-malignant lesions by cytology is 4.5%, which falls within the parameters provided by the WHO. The study of these cases confirms the high degree of sensitivity of cytology. For women who were tested a second time, the number of pre-malignant lesions revealed was not significant, so this procedure is more for quality control. When the programme began, only 0.4% of carcinomas were pre-invasive, compared to 42.1% now! Before the programme, only 18.6% of patients were able to be treated surgically, whilst now, 74.4% are able to benefit this way. The main problem continues to be the lack of definitions of the role of the Health Centres in the screening programme.