- Email: [email protected]
Global strategies for cervical cancer control in the 21st century
Gynecologic Oncology 99 (2005) S245 www.elsevier.com/locate/ygyno
Conference Report Global strategies for cervical cancer control in the 21st centuryB The global strategy for the management of cervical cancer and its precursors must take into account the setting: high resources, medium resources, and low resources. There are seven areas that make up effective programs: prevention, screening, diagnosis, treatment, quality of life, survivorship, and end of life care. Primary preventive strategies in all settings include: encouraging abstinence and monogamy, making the sexual debut later in life, lowering the number of sexual partners, increasing the use of condoms, and the implementation of vaccines against Human Papillomavirus (HPV). Screening in high resource settings requires that registries are created so that patients can be contacted for follow-up treatment and care. There are barriers to care even in high resource settings: obesity, immigrant status, lesbians, nonEnglish speakers, urban poor, and rural poor. There is often redundancy in high resource settings. Even in these settings, the accuracy of the screening tests could improve. In medium resource settings, registries could be considered. HPV testing might be a more sensitive test than cytology in these settings. The programs should target women at highest risk. Screening needs to be integrated into the health care system. In low resource settings, women may only be screened one or twice in their lifetime. There may be more cost-effective screens than cytology; e.g. visual inspection using acetic acid, visual inspection using Lugol’s solution, screening colposcopy, cervicography, or see and treat colposcopy. Once vaccines are introduced, policies may change. The duration of protection from vaccines is currently unknown. HPV subtypes may not all be covered by certain of the vaccines. There could probably be decreased screening for those women vaccinated with polyvalent vaccines and those populations mass-vaccinated. Once diagnosed, patients need treatment and follow-up. A strategy that could reduce the costs associated with tracking, contacting, and scheduling patients, is a see-andtreat approach so that both diagnosis and treatment occur in
B
a single visit. Tests that increase the accuracy of follow-up visits would add value to the health care system. The best use of the subspecialty care available would ensure the appropriateness of referrals to gynecologic, radiation, and medical oncologists. The treatment of patients is critical to the process. Both patients with pre-invasive and invasive cancer need access to prompt treatment from interested physicians. The quality of life should remain at the forefront of care. Attention to survivorship and the lessening of complications arising from curative therapies are important. There must be access to end of life care, including sufficient pain management and resources, so that patients with recurrences or progressive disease die comfortably. A new effort to reduce redundancy and leverage resources for women with cancer is called the Global Initiative in Women’s Cancers or GLOW. This program addresses breast cancer, gynecologic cancers, and tobacco control. The GLOW program has been endorsed by the World Health Organization, the International Agency for Cancer Research, the International Union Against Cancer (UICC), the International Gynecologic Cancer Society, the American Cancer Society, the Society of Gynecologic Oncologists, the Society of Surgical Oncologists, the Gynecologic Cancer Foundation, the European Society of Gynecologic Oncologists, and the Gates Foundation. GLOW hopes to sponsor satellite meetings, free-standing meetings, visiting professorships, and visiting scholars. The GLOW program also hopes to conduct needs assessments, run pilot programs, and assess resources for redundancy. In addition, needs must be addressed for: hospice programs; training of additional gynecologic, radiation, and medical oncologists; integration of screening programs with national health care systems; increase the availability of treatments; and increasing access to end of life care. Ted Trimble National Cancer Institute, 6130 Executive Blvd., Suite 741, MSC 7436, Bethesda, MD 20892-7436, USA E-mail address: [email protected].
This report is based on a presentation given at the 4th International Conference on Cervical Cancer and was prepared in part by Michele Follen.
doi:10.1016/j.ygyno.2005.07.096
Conference Report Global strategies for cervical cancer control in the 21st centuryB The global strategy for the management of cervical cancer and its precursors must take into account the setting: high resources, medium resources, and low resources. There are seven areas that make up effective programs: prevention, screening, diagnosis, treatment, quality of life, survivorship, and end of life care. Primary preventive strategies in all settings include: encouraging abstinence and monogamy, making the sexual debut later in life, lowering the number of sexual partners, increasing the use of condoms, and the implementation of vaccines against Human Papillomavirus (HPV). Screening in high resource settings requires that registries are created so that patients can be contacted for follow-up treatment and care. There are barriers to care even in high resource settings: obesity, immigrant status, lesbians, nonEnglish speakers, urban poor, and rural poor. There is often redundancy in high resource settings. Even in these settings, the accuracy of the screening tests could improve. In medium resource settings, registries could be considered. HPV testing might be a more sensitive test than cytology in these settings. The programs should target women at highest risk. Screening needs to be integrated into the health care system. In low resource settings, women may only be screened one or twice in their lifetime. There may be more cost-effective screens than cytology; e.g. visual inspection using acetic acid, visual inspection using Lugol’s solution, screening colposcopy, cervicography, or see and treat colposcopy. Once vaccines are introduced, policies may change. The duration of protection from vaccines is currently unknown. HPV subtypes may not all be covered by certain of the vaccines. There could probably be decreased screening for those women vaccinated with polyvalent vaccines and those populations mass-vaccinated. Once diagnosed, patients need treatment and follow-up. A strategy that could reduce the costs associated with tracking, contacting, and scheduling patients, is a see-andtreat approach so that both diagnosis and treatment occur in
B
a single visit. Tests that increase the accuracy of follow-up visits would add value to the health care system. The best use of the subspecialty care available would ensure the appropriateness of referrals to gynecologic, radiation, and medical oncologists. The treatment of patients is critical to the process. Both patients with pre-invasive and invasive cancer need access to prompt treatment from interested physicians. The quality of life should remain at the forefront of care. Attention to survivorship and the lessening of complications arising from curative therapies are important. There must be access to end of life care, including sufficient pain management and resources, so that patients with recurrences or progressive disease die comfortably. A new effort to reduce redundancy and leverage resources for women with cancer is called the Global Initiative in Women’s Cancers or GLOW. This program addresses breast cancer, gynecologic cancers, and tobacco control. The GLOW program has been endorsed by the World Health Organization, the International Agency for Cancer Research, the International Union Against Cancer (UICC), the International Gynecologic Cancer Society, the American Cancer Society, the Society of Gynecologic Oncologists, the Society of Surgical Oncologists, the Gynecologic Cancer Foundation, the European Society of Gynecologic Oncologists, and the Gates Foundation. GLOW hopes to sponsor satellite meetings, free-standing meetings, visiting professorships, and visiting scholars. The GLOW program also hopes to conduct needs assessments, run pilot programs, and assess resources for redundancy. In addition, needs must be addressed for: hospice programs; training of additional gynecologic, radiation, and medical oncologists; integration of screening programs with national health care systems; increase the availability of treatments; and increasing access to end of life care. Ted Trimble National Cancer Institute, 6130 Executive Blvd., Suite 741, MSC 7436, Bethesda, MD 20892-7436, USA E-mail address: [email protected].
This report is based on a presentation given at the 4th International Conference on Cervical Cancer and was prepared in part by Michele Follen.
doi:10.1016/j.ygyno.2005.07.096