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The need to revamp cervical cancer prevention programs

According to experts who conducted a study of Australian cervical cancer rates, there is a pressing need to revamp the cervical cancer prevention program. //New vaccines against the causative virus and tests for its detection need to be introduced at a large scale.

Currently, Australian women are recommended to get Pap smear tests done once in 2 years. However, the cancer experts say that this gap of 2 years can be increased to 3 as in the U.K. without any fears of delay. In a Pap smear test, the cells from the cervix are microscopically examined for detection of curable pre-cancerous alterations.

A comparative study of screening programs in Australia and Britain was done that revealed same levels of reduction in death rates over a period of 10 years, in spite of certain parts of U.K. recommending 3-yearly Pap smear.

The study carried out by the Cancer Council and Oxford University revealed that there was a 33% reduction in cervical cancer deaths in both the countries during the period 1998-2000 when compared to the period 1991-1993.

The study was published this week in The Medical Journal of Australia. "Most of the cancers were diagnosed in women who had never had a Pap smear, or had one more than three years previously, " said Dr Penman chief executive of the Cancer Council NSW. "Money might be better spent reaching that group - and Aboriginal women who were also at elevated risk - than on frequent rescreening of low-risk women," he said.

The risk of cervical cancer death has been reduced to 1/3rds ever since the introduction of Pap screening in the early 1980s.

Dr Penman said, "Any review should consider the role of the vaccine Gardasil, which protects against strains of the sexually transmitted human papilloma virus implicated in cervical cancer development. Gardasil's developer, CSL, has proposed a public program to immunise adolescent girls before they are sexually active. "

Gerry Wai n, Director of gynaecological oncology at Westmead Hospital, said "There are so many cards on the table. The answer is not obvious. The screening program [as presently organised] has probably run its course."

Dr Wain said, "The virus tests are a potential addition to the prevention repertoire, although they cannot show how long the virus had been present in the cervix - important because most infections clear up spontaneously and only persistent cases develop into cancer. "

The chief executive of the Royal College of Pathologists of Australasia, Debra Graves, said, "The system of recalling women for repeat smears needs improving before extending the interval. If [women wait] longer than three years it gets dangerous."

The chief executive of the National Health and Medical Research Council will examine the report and suggest a review of screening if required.
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