CHAPTER 4: SCREENING FOR CERVICAL CANCER

84Chapter 4: Screening for Cervical CancerOrganized and opportunistic cervical cancer screening4Chapter 4: Screening for Cervical CancerOrganized screeningOrganized screening is designed to reach the highest possible number of women atgreatest risk of cervical cancer with existing resources. It is usually planned at thenational or regional level. An organized screening programme should specify:• the target population;• screening intervals;• coverage goals;• a mechanism for inviting women to attend screening services;• the screening test or tests to be used;• the strategies to ensure that all women found positive on screening are informed oftheir result;• a mechanism for referring women for diagnosis and treatment;• treatment recommendations;• indicators for monitoring and evaluating the screening programme.Opportunistic screeningOpportunistic screening is screening done independently of an organized or populationbasedprogramme, on women who are visiting health services for other reasons.Screening may be recommended by a provider during a consultation, or requested by awoman. Opportunistic screening tends to reach younger women at lower risk, who areattending antenatal, child health and family planning services.It is generally accepted that organized screening is more cost-effective thanopportunistic screening, making better use of available resources and ensuring thatthe greatest number of women will benefit. However, both organized and opportunisticscreening can fail because of poor quality-control, low coverage of the population atrisk, overscreening of low-risk populations, and high loss to follow-up.Benefits and risks of screeningThe benefits and risks of screening should be discussed with women as part of generalhealth education and before obtaining informed consent. The benefits of screeninghave been described in previous chapters. However, as with all large efforts directedtowards healthy populations, screening for cervical cancer has the potential to produceundesirable outcomes, such as:• psychological consequences – anxiety and fear about being tested for cancer;• a mistaken belief that a positive test is a cancer diagnosis;