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1、WHO’scervicalcancerscreeningprogrammesmanagerial：誰的宮頸癌篩查項目管理WhoamI?Education:MSc(Epidemiology),TheAgaKhanUniversity,2001.Thesis:CareandfeedingpracticesandtheirassociationwithstuntingamongyoungchildrenresidinginKarachi-ssquattersettlementsBBA(Management),TheCollegeofWilliamandMary,Williams
2、burg,VA,USA,1989Researchinterest:Nutritionalandbehavioralepidemiology,methodologicalissuesindietaryassessmentmethods,householdfoodsecurityandgender-relatedissues,careandfeedingpractices,managementofdataandquestionnairedesigningLearningObjectivesTounderstandtheimportanceofestablishingacerv
3、icalcancerscreeningprogrammeTobefamiliarwiththeWHOrecommendedmanagerialfactorstoconsiderpriortosettingupascreeningprogrammeTounderstandtheconceptof“downstaging”intermsofcervicalcancerscreeningManagerialfactorstoconsiderwhensettingupascreeningprogrammeFormulationofscreeningprogrammesThenat
4、uralhistoryofcervicalcancerImplicationsofscreeningpolicyServicedeliveryInformationsystemsProgrammeevaluationDownstagingwherecytologicalscreeningnotpossibleNaturalHistoryCervicalcancerdevelopsslowly,andthekeyprecursorisseveredysplasia.Thenaturalhistorybeginswiththeonsetofsexualactivityatab
5、outage13,cervicaldysplasiaappearsaboutage18through35yearsCarcinomainsitubeginsaboutage35yearsthroughtoaboutage50wheninvasivecancersbegintoappearasapreludetodeathataboutage55.RiskFactorsidentifiedHumanpapillomavirus(HPVDNAispresent93%ofcervicalcanceranditsprecursorlesions)Epidemiologicstud
6、iesongoingoncofactorsandhostfactorsthatmayexplainthenaturalhistoryofHPVinfectionsandtheirassociatedlesions.Factorsunderinvestigationincludesmoking;useofhormonalcontraceptives;numberoflivebirths;youngageatfirstsexualintercourse;useofvitaminssuchascarotenoids,vitaminC,andfolicacid;co-infect
7、ionwithothersexuallytransmitteddiseases(e.g.,herpessimplex,HIV,chlamydia);growthfactorsImplementationandevaluationofcervicalscreeningDecisiontoimplementscreeningforcervicalcancershouldbebasedon:EvidencethatcervicalcancerisamajorhealthproblemCharacteristicsofindividu
