Cervical cancer incidence and mortality in the best and worst of worlds.
BACKGROUND
Globally speaking, cervical cancer is a common cause of death. The cancer is caused by a human papillomavirus (HPV) infection, and hence is preventable. Pap smear screening allows for the early detection of precancerous lesions that are easily treated in a pre-invasive phase of the disease. New tests and treatment methods have the overall aim of lowering cervix cancer incidence and death. However, whether a woman will or will not develop cervix cancer depends on a complex number of interacting variables.


OBJECTIVE
The aim of the present study was to identify factors that might have an impact on cervix cancer incidence and mortality, and rank them according to the weight of their relative influence.


METHODS
By using a forecasting model called the scenario method, factors were identified that could have an impact on cervix cancer development, and their relative importance was ranked by using a special matrix. The figures given for each factor were summed and presented in a System Grid, which made it possible to determine the most important variable.


RESULTS
The cultural structure of the female population, as well as women's habits and behaviour, all seem to be more important factors than the Pap smear test or the treatment in relation to cervical cancer incidence and mortality.


CONCLUSIONS
In the endeavour to prevent cervical cancer one must consider the whole chain of events, i.e. population-tests-treatment-outcome. New and improved test methods and treatment procedures are of little use if women refrain from coming for a test when called.
Rydström
Catrine
C
Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Törnberg
Sven
S
D000328:Adult; D000368:Aged; D005260:Female; D005544:Forecasting; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000191:economics / Q000458:organization & administration / Q000592:standards; D008875:Middle Aged; D008962:Models, Theoretical; D017063:Outcome Assessment, Health Care; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000302:isolation & purification; D013548:Sweden / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control / Q000821:virology; D014626:Vaginal Smears