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The screening of Cervix Uteri cancer should theoretically be the most efficient cancer screening since it can detect pre-cancerous lesions and avoid the development of cancer. Once the cancerisation process is engaged, it can detect in situ cancers (i.e. for which 100% of patients can be cured). Even with more advanced disease (T1 and proximal T2), curing probability remains high.

Recommendation

Cervix Uteri cancer screening is based on the regular and systematic realisation of a cervico-vaginal smear every 3 years from the beginning of sexual activity up to the age of 65.

This recommendation is simple but its application proves to be difficult due to:

• lack of means,
• technical difficulties (in reality easy to solve),
• the psychological difficulties in accepting such screening, mainly among uneducated or marginal women.

Thus, a great number of women avoid this simple technique and unfortunately are treated for already invasive carcinoma when they present abnormal vaginal bleeding.

One of the major advantages of the pap smear is the possibility of discovering and treating pre-cancerous lesions (dysplasia also called intra-epithelial neoplasia).

In every country where systematic screening campaigns have been organised (like in the United Kingdom or in Iceland), the mortality rate by cervix uteri carcinoma sharply diminishes (see British and French registries).

Unfortunately, in France, like in many other countries, such campaigns are not organised. Quoting cultural differences between Anglo-Saxon and Mediterranean countries is a false argument for not applying such a policy: in the department of Doubs (in Eastern France), a clear local political commitment and many volunteers have led to a significant decrease in the mortality rate by this cancer.

Clear financing of the campaign should also be made available in order to allow poor and disadvantaged women to benefit from the program.

Technical problems

The pap smear technique is simple: it needs to be learned by every general practitioner or cancer nurse. It is a painless procedure but is sometimes faced with strong prudish feelings (particularly for certain immigrants). A correct exposition of the cervix is necessary to obtain a good quality smear of the cervix junction.

Quality control is high for the cytologists (at least in France) and a clear interpretation description has been defined by Pathologist Societies.

A very simple lexicon may help to understand these cytological reports.

A simple attitude can be adopted according to results:

This scheme is inspired by the Canadian Health Ministry.

We have the means to almost make this cancer disappear: but it is not a very ‘chic’ cancer: many of its victims have neither the time, the knowledge, the means, nor the will to be screened. Only a clear political commitment could help solve this problem and offer the same great success as seen in certain Scandinavian countries.