Recent advances and problems in primary therapy for cervical cancer in Taiwan

Cervical cancer is a serious health problem in Taiwan, with nearly 2700 women developing the disease each year. The estimated incidence of this disease from 1993 to 1997 was 21.8 per 100,000 woman-years. The lack of effective Papanicolaou smear screening systems was the major cause of the high prevalence rate before 1995. Surgery and radiotherapy are the standard treatments for early stage cervical cancer. For women with advanced stage cervical cancer, external-beam pelvic radiation followed by intracavitary radiotherapy is the treatment of choice. Although randomized clinical trials have shown that concurrent chemoradiotherapy should be regarded as the standard treatment for locally advanced cervical cancer (stage IIB to IVA), the impact of the complications associated with this treatment have not been evaluated in Taiwanese studies. Localized bulky (stage IB2 or bulky IIA) tumors are commonly treated with various combinations of chemotherapy, surgery and radiotherapy, despite unresolved concerns about the morbidity and effectiveness of this approach compared with definitive radiotherapy or radical surgery. Although about 60% of Taiwanese women with cervical cancer receive primary surgical treatment, about 20% do not receive treatment or receive non-standard therapies. Efforts are needed to increase the screening rate, to improve access to medical care, and to provide public education for patients to reduce the occurrence and mortality of cervical cancer in Taiwan.