Recommendations for cervical cancer screening programs in developing countries. The need for equity and technological development

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"The cervical cancer screening programs (CCSP) have not beenvery efficient in the developing countries. This explains the needto foster changes on policies, standards, quality control mechanisms,evaluation and integration of new screening alternativesconsidered as low and high cost, as well as to regulatecolposcopy practices and the foundation of HPV laboratories.Cervical cancer (CC) is a disease most frequently found inpoverty-stricken communities and reflecting a problem of equityat both levels gender and regional, and this, is not only due tosocial and economic development inequalities, but to the infrastructureand human resources necessary for primary care.For this reason, the CCSP program must be restructured, a)to primarily address unprivileged rural and urban areas; b) tofoster actions aimed at ensuring extensive coverage as well asa similar quality of that coverage in every region; c) to usescreening strategies in keeping with the availability of healthcare services. In countries with a great regional heterogeneity,a variety of screening procedures must be regulated and standardized,including a combination of assisted visual inspection,cervical cytology and HPV detection; d) regional communityintervention must be set up to assess the effectiveness of usingHPV detection as an strategy in addition to cervical cytology (pap smear); e) the practice of colposcopy must be regulatedto prevent the use of it in healthy women at a population level,thus preventing unnecessary diagnosis and treatment whichnot only are expensive but also causes unnecessary anxiety towomen at risk; f) the operation of those clinical laboratoriesusing HPV as a detection strategy must likewise be accreditedand regulated and g) the CCSP program for assuring healthcare quality should meet the expectations of its beneficiaries,and increase the knowledge in cervical cancer related matters.Finally, though a variety of clinical tests on prophylactic andtherapeutic vaccines against HPV are recently being developedworldwide; it will take at least from 5 to 10-years time tohave them available in the market. For this reason, it will benecessary to intensify the CCSP programs. All these reasonslay emphasis on the need to reinforce actions for CCSP programs.This paper is available too at: http://www.insp.mx/salud/index.html"