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

Background Mexico established a national cervical cancer-screening program in 1974, Despite the implementation of the program, there was a steady mort ality trend of 16 per 100,000 women over 15 years. Methods. A diagnostic procedure of the pitfalls was applied to the followin g steps of the screening procedure: Pap sampling quality; cytological diagn osis validity; compliance of women; and determinants of non-participation. Results. The low effectiveness of screening on cervical cancer is principal ly due to factors associated with quality and coverage. Pap quality is defi cient; 64% of a random sample of specimens lacked endocervical cells. Readi ng centers presented false negative indices of between 10 and 54%. Women se ek screening in a late stage of disease (55% with cervical cancer seek care because they have symptoms). Tn addition, coverage is low; in women betwee n 15 and 49 years of age in Mexico City, 64.2% have a history of Pap, compa red 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 inf ormed about the purpose of the Pap test. Conclusions. A proposal to reorganize Mexico's screening program includes t he following five main strategies: (a) increased coverage; (b) improved qua lity control of how cervical smears are taken; (c) better interpretation of Pap tests: (d) guaranteed treatment for those whose tests show abnormaliti es, and (e) improved follow-up. (C) 1999 IMSS, Published by Elsevier Scienc e Inc.