Publication of Fifth Edition of Cancer Control

The fifth edition of INCTR's annual Journal, Cancer Control has been published.

This edition contains 12 articles, including a whole section (4 articles) on the control of uterine cervical cancer the most common cancer of women with limited resources. A high proportion of these women live in hard-to-reach rural regions or tribal regions in countries such as India. Good coverage of the public by means of early diagnosis or screening (by definition, symptom free) is essential if an impact is to be made at the population level (which is not an easy task and also requires significant expenditure). The problems of prevention programs are, therefore, quite different to those encountered of the treatment of symptomatic malignant lesions, the treatment of which usually includes extensive surgery or radiation therapy and detailed staging studies. Treatment, then, is expensive and requires highly skilled health professionals and access to radiaotherapy equipment (or surgeons capable of performing major operations) at the individual patient level, while screening and treating pre-malignant lesions can be conducted with minimal facilities and much less highly trained staff, but requires screening of very large populations, a process which requires good management and incentives that persuade women of the need for screening as well as excellent organisation if the major part of the femalePopulation to be screened female population is to be screened. Costs will vary from population to population (the map shows the variation in incidence across the world, which determines the need for screening, although it must be remembered that in high-income countries, the map is showing incidence where screening is widely available and the incidence would be higher if screening was not performed on a high fraction of the population.

Regardless of the simplicity of screening followed by simple treatment such as freezing the cervix, the fact that so many women must be examined result in considerable cost, and re-training of the health workers who do the screening. A gynaecologist may be required to destroy the potentially malignant cells in screen-positive women. New devices are under development to enable treatment in the field. Their advantages include the possibility of receiving medical care - including education about the prevention of cancer and diagnosis and treatment only a short distance from home (since the medical team goes to the women instead of vice-versa). Keeping good records will enable medical teams to know which individuals have received information on the diagnoses of cancer so that a maximum of women from the community are examined.

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