Cervical cancer screening in developing countries: why is it ineffective? The case of Mexico

ABSTRACT

Background. Mexico established a national cervical cancer-screening program in 1974. Despite the implementation of the program, there was a steady mortality trend of 16 per 1000,000 women over 15 years. Methods. A diagnostic procedure of the pitfalls was applied to the following steps of the screening procedure Pap sampling quality; cytological diagnosis validity; compliance of women; and determinants of non-participation. Results. The low effictiveness of screening on cervical cancer is principally due to factors associated with quality and coverage. Pap quality is deficient; 64 percent of a random sample of specimens lacked endocervical cells Reading center presented false negative indices of between 10 and 54 percent. Women seek screening in a late stage of disease (55 percent with cervical cancer seek care because they have symptoms). In addition, coverage is low; in women between 15 and 49 years of age in Mexico City, 64.2 percent have a history of Pap, compared with 30 percent in rural areas. Knowledge of what the Pap in used for strongly determines the use of screening. In rural areas, only 40 percent of women are informed about the purpose of the Pap test. Conclusions. A proposal to reorganize Mexico's screening program includes the following five main strategies (a) increased coverage; (b) improved quelity control of how cervical smears are taken; (c) better interpretation of Pap test; (d) guaranteed treatment for those whose tests show abnormalities, and (e) improved follow-up