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Foreword

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Cervical cancer is an important public health problem worldwide, particularly in the developing countries of south and south-east Asia, sub-Saharan Africa and central and south America. If nothing is done to control it, the burden of cervix cancer will grow rapidly and developing countries will be badly affected. Cervical cancer screening is of proven efficacy and cervical cytology is the most widely used screening test. However, the existing cervical cytology programmes in developing countries have largely been ineffective in reducing cervical cancer burden there, partly due to factors such as sub-optimal performance of cytology and lack of quality assurance. Histopathology is essential to establish the final diagnosis. The aim of this digital atlas is to improve the technical standards of the practice of cervical cytology and histopathology and to contribute to improving the quality of cytology screening and histological diagnoses of these lesions, particularly in countries with limited resources where investments in cytology screening have been made.

This atlas is based on the following international references:

• WHO Classification (2003) for histopathology
• TNM Classification (2003) and the FIGO (2002) for staging
• The Bethesda system (2001) for the summary of cytopathology

This is one of a series of publications from the Screening Group of the Agency in the domain of early detection and prevention of cervical cancer. It is intended for use by pathologists, technicians and cytotechnologists, as well as gynaecologists. It is also recommended for the training of specialist interns and histo- and cytotechnology technicians. It can be used as an initial teaching tool, for progressive self-training and evaluation, as well as for quality assurance.

This interactive CD-ROM contains more than 1200 images, which come in part from on-going and completed IARC cervical cancer screening studies in various developing countries. These studies were supported by the Bill & Melinda Gates Foundation through the Alliance for Cervical Cancer Prevention, and have been carried out in collaboration with national institutions in those countries. The images have been reviewed in depth and selected by the editors as well as by several review pathologists.

This publication is not intended to be either exhaustive or encyclopaedic. It focuses on current problems commonly encountered in the cytological interpretations and histological diagnosis of lesions, which currently represents "the gold standard" reference diagnosis. Attention is drawn to pitfalls in cytological interpretation and histological diagnosis. Certain specialised techniques such as immunohistochemistry, electronic microscopy, in situ hybridization and PCR are described and/or illustrated when they contribute to the understanding of lesions. Though they should not be considered as indispensable for day-to-day diagnosis, the CD-ROM does underline the importance of the quality of samples and laboratory techniques for optimal interpretation.

I am sure that this digital learning resource will further contribute to improving standards of cervical cytology screening and histological diagnosis in less resourced countries, and will contribute to further improvements in women's health, particularly in the prevention, early detection and successful treatment of cervical cancer.



Peter Boyle, Ph.D.
Director
International Agency for Research on Cancer