Cervical Cancer Screening in Developing Countries: Why Is It Ineffective? The Case of Mexico

• Published in: Archives of medical research Vol. 30; no. 3; pp. 240 - 250
• Main Authors: Lazcano-Ponce, Eduardo César, Moss, Sue, de Ruı́z, Patricia Alonso, Castro, Jorge Salmerón, Avila, Mauricio Hernández
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.1999
• Subjects: Adolescent; Adult; Cervical cancer; Cross-Sectional Studies; Female; Humans; Mass Screening - methods; Mexico; Middle Aged; Pap test; Quality; Screening; Uterine Cervical Neoplasms - diagnosis; Women’s health; Mexico; Screening; Pap test; Women’s health; Quality; Cervical cancer
• ISSN: 0188-4409; 1873-5487
• DOI: 10.1016/S0188-0128(99)00006-8

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 100,000 women over 15 years. 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. The low effectiveness of screening on cervical cancer is principally due to factors associated with quality and coverage. Pap quality is deficient; 64% of a random sample of specimens lacked endocervical cells. Reading centers presented false negative indices of between 10 and 54%. Women seek screening in a late stage of disease (55% 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% have a history of Pap, compared with 30% in rural areas. Knowledge of what the Pap is used for strongly determines the use of screening. In rural areas, only 40% of women are informed about the purpose of the Pap test. A proposal to reorganize Mexico’s screening program includes the following five main strategies: (a) increased coverage; (b) improved quality control of how cervical smears are taken; (c) better interpretation of Pap tests; (d) guaranteed treatment for those whose tests show abnormalities, and (e) improved follow-up.