[IMPLEMENTATION OF A NATIONAL SCREENING PROGRAM FOR DETECTION OF MALIGNANT AND PRE-MALIGNANT CERVICAL MORBIDITY IN...

The natural development of cervical cancer, which takes many years, is mostly initiated by infection with human papillomavirus (HPV) and is characterized by the development of precancerous lesions, cervical intraepithelial neoplasia 3 (CIN3), which are defined as abnormal changes in epithelial cells that cover the cervix surface. Since the pre-cancerous process is microscopic and asymptomatic, early detection is based on cytological screening, the Pap test. In Israel, Pap tests are performed based on selfreferral for testing and not within the framework of a national screening program because of the low incidence rate of cervical cancer in Israel. The current program is characterized by low coverage rates, redundancy checks conducted on a small and selective group of women and therefore, lower efficacy in comparison to an organized, national program. In recent decades, the incidence rates of pre-malignant and malignant cervical morbidity showed increasing trends in Israel, an increase which can be stopped. Launching a national, organized program for the early detection of cervical cancer using Pap test and raising the awareness of women and physicians in Israel regarding the importance of this test, will increase the test uptake and decrease its current selectiveness. Furthermore, this will, in the short run, improve serious cervical morbidity, and in the long run, also reduce the incidence of precancerous and cancerous cervical lesions, as has been described in many countries in the world.