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BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1996; 74(4):345-51.This memorandum summarizes the report of a World Health Organization (WHO) Consultation on the Control of Cervical Cancer in Developing Countries held in November 1994 in New Delhi, India. The WHO international study group analyzes and evaluates the feasibility and validity of various low-cost strategies for cervical cancer screening in low resource settings compared with cytology (i.e., Pap smear). It focuses on the effect of health education and empowerment of women and the effect of the clinical downstaging approach (i.e., simple visual inspection of the cervix of asymptomatic women). The group agreed on a model protocol for a controlled randomized study designed to evaluate the applicability and cost-effectiveness of different approaches to the early detection of cervical cancer in developing countries. The protocol consists of four study arms: control group, health education only group, health education and visual inspection, and health education and Pap smears. The participants analyzed experiences from the UK, South Africa (Cape Town and Orange Free State), India (Delhi and Bangalore), and Nordic countries (Sweden and Finland). They also examined prospective studies on cervical cancer screening in Zimbabwe, the UK, India, Bangladesh, Philippines, Brazil, and Malaysia. Clinicians and public health officials need to recognize cervical cancer as a major but soluble health problem among women in most developing countries. Health education about cervical cancer, its signs and symptoms, and its curability as well as health education about their own reproductive health could empower women and therefore have a major impact. Availability of standard therapy and appropriate management and effective early detection and referral policies are needed to minimize morbidity and mortality from cervical cancer. Researchers need to conduct controlled studies to examine ways that are most effective in empowering women. Visual inspection and quality controlled cytology screening should be evaluated. Early detection and other clinical aspects should be done simultaneously.
FORUM. 1996 Dec; 12(2):14.While the government of St. Lucia actively supports family planning and the Ministry of Health maintains a service delivery program, the Saint Lucia Planned Parenthood Association (SLPPA) is also involved in getting family planning messages and a variety of services to the public at minimal cost. The work schedules of factory workers in St. Lucia's manufacturing sector prohibit them from visiting family planning clinics, doctors' offices, and distribution posts to obtain contraceptives. SLPPA staff members therefore go to 12 selected factories to provide female employees with family planning information and contraceptive methods. 90% of employees at these factories are female. The outreach team of one nurse midwife, a counselor, and a trained factory distributor visit the factories twice each month during which they also teach women on sexual and reproductive health, responsible family life, and relationships. More than 2000 factory workers currently have access to SLPPA services. In 1996, more than 1000 workers had individual counseling sessions on sexual and reproductive health. The SLPPA also reaches women through other non-contraception initiatives such as the early detection of cervical and breast cancer.
JOURNAL OF REPRODUCTIVE MEDICINE. 1996 May; 41(5 Suppl):419-25.This article reviews recent epidemiological data assessing the risk of breast, endometrial, ovarian, and cervical cancer in women using the injectable contraceptive depot medroxyprogesterone acetate (DMPA). A review is also provided of epidemiological and biostatistical concepts which relate to the literature on the relationship between the use of hormonal contraception and cancer. Breast cancer is a common and lethal disease in the US, and evidence suggests that gonadal steroids play a role in the development of breast cancer. Two major case control studies (one in New Zealand and the other under the auspices of the World Health Organization [WHO]) as well as a pooled analysis of these studies found no increased overall breast cancer risk in DMPA users. A currently unexplained pattern of increased risk in recent users mimics that seen with oral contraceptive (OC) use and term pregnancy. A WHO hospital-based study of the relationship between endometrial cancer and DMPA use found a protective effect of DMPA which appeared to be longterm and as great as that associated with OCs. Whereas it is plausible that DMPA, which suppresses ovulation, would lower the risk of ovarian cancer in users, a WHO case-control and hospital-based study failed to uncover such a protective effect. Studies of the routine use of DMPA in nulliparous women (who have higher risk of ovarian cancer) will shed more light on any effect DMPA may have on ovarian cancer. The unique epidemiology of cervical cancer (including number of sexual partners, use of barrier contraception, and frequent screening) makes it difficult to assess any association with contraceptive use. However, a large population-based, case-control study in Costa Rica; a WHO hospital-based, case-control study in Thailand, Mexico, and Kenya; and a study in New Zealand indicate that the risk of cervical neoplasia does not appear to be affected by DMPA use. While some issues regarding DMPA and the risk of reproductive tract carcinoma remain to be resolved, clinicians can be reassured that, for appropriately selected clients, the substantial benefits of DMPA outweigh any risks.