Factors affecting the quality of service

There are many factors that can affect the quality of cervical cancer prevention program. Because the effectiveness of cytological screening is not 100%, a great number of non progressive mild lesions are detected and, on the other hand, cervical carcinomas are still diagnosed in women who have been screened. Selection for diagnosis of low-grade cytology is an unsolved problem, confronting the possibility of overdiagnosis and eventually overtreatment with the risk of missing a high-grade lesion. Endocervical or vaginal lesions or CIN associated with an unsuspected glandular neoplasia are the most frequent causes of colposcopic diagnostic errors. Escisional methods of treatment are preferred. Ablative techniques must be used only after a careful diagnostic study. Selected low-grade lesions can be followed without treatment. Treated CIN patients remains at increased risk for carcinoma, so prolonged follow up is mandatory.