**4. Gynecological cancer screening intervals**

In many countries, undergoing cancer screening is not mandatory but voluntary. Many women are advised to annual gynecological screening for more than a decade. Recently, recommendations of many developed countries include one Pap smear every 3 years after two annual negative results from the age of 18 until 69 years [26]. According to the current American Cancer Society guidelines, adequate negative prior screening and no history of CIN 2 of higher recommend that cervical smear test stops at age 65 [27]. On the other hand, annual screening continues among women of 65 years of age and older, even among those with less than a 5-year life expectancy due to poor health [28]. Likely, as clinical practice continues to change around the screening pelvic examination, consequent changes in utilization of reproductive health services among young adolescence to postmenopausal.

First care visit volume is a key step for continuous use of an extended screening interval, with women who report to first gynecologic care visit during the last year being over 10 times more likely to report current use of a 3-year screening interval than those with three or more visits. It is not possible to separate which come first of less-frequent care seeking and an extended gynecological cancers (including uterine and ovarian malignancies) screening interval. Clearly, some women are screened on 3-year intervals by default; however, others who purposefully follow an extended screening interval may have no perceived need to seek care during a given year.

The continuous screening preference of Japanese women may reflect long-held beliefs about the importance of annual cervical smear examinations and pelvic ultrasonographic examination with limited awareness of the potential harms associated with this practice. The level of knowledge and attitude toward screening are related to multiple factors such as ethnicity, place of residence, income, and social-economic status [29]. From an examiner perspective, annual gynecologic cancer screening has facilitated regular contact with examinees. In general, women are invited by their gynecologists for the examination. The cytologic screening time interval depends on the doctor's personal judgment [30]. If he feels that the test will benefit their patients, the likelihood of performing the test increases. Some systemic review found a positive correlation of educational level, financial status, and an awareness of the mortality rates associated gynecological cancer with gynecological cancer attendance [26, 31, 32]. The level of knowledge and attitude toward health check-up are related to multiple factors such as ethnicity, place of residence, income, and social-economic status [33–37].

## **5. Discussion**

Uterine cancer, in particular cervical cancer, is preventable. More than half of the women diagnosed with cervical cancer have not attended screening in the past 3 years. A community-based screening strategy is one of the greatest success stories in cancer prevention, and widespread screening reduces the cervical cancer incidence worldwide [38–42]. The mean time between the virus infection and invasive cancer takes about 15 years, and within 2–4 years of detection 15.5–25.5% of low-grade epithelial lesions become high-grade lesions. In some cases, these more severe changes can develop into cervical cancer [5–10]. A routine screening test includes cytology smear test used for the detection of early cervical abnormalities (precancerous dysplastic changes) of the uterine cervix [5–10]. The screening is a relatively simple, low cost, and noninvasive method. Concurrent transvaginal ultrasonography for detection of ovarian and uterine tumors, the cervical and endometrial cytology smear tests attenuate the probability of developing gynecological malignant diseases.

stage tumors, as well as improving imaging sensitivity to allow for detection of tubal lesions. So far, multimodal screening strategy in which blood-based assay is positive, and subsequent

In many countries, undergoing cancer screening is not mandatory but voluntary. Many women are advised to annual gynecological screening for more than a decade. Recently, recommendations of many developed countries include one Pap smear every 3 years after two annual negative results from the age of 18 until 69 years [26]. According to the current American Cancer Society guidelines, adequate negative prior screening and no history of CIN 2 of higher recommend that cervical smear test stops at age 65 [27]. On the other hand, annual screening continues among women of 65 years of age and older, even among those with less than a 5-year life expectancy due to poor health [28]. Likely, as clinical practice continues to change around the screening pelvic examination, consequent changes in utilization of repro-

First care visit volume is a key step for continuous use of an extended screening interval, with women who report to first gynecologic care visit during the last year being over 10 times more likely to report current use of a 3-year screening interval than those with three or more visits. It is not possible to separate which come first of less-frequent care seeking and an extended gynecological cancers (including uterine and ovarian malignancies) screening interval. Clearly, some women are screened on 3-year intervals by default; however, others who purposefully follow an extended screening interval may have no perceived need to seek care during a given year.

The continuous screening preference of Japanese women may reflect long-held beliefs about the importance of annual cervical smear examinations and pelvic ultrasonographic examination with limited awareness of the potential harms associated with this practice. The level of knowledge and attitude toward screening are related to multiple factors such as ethnicity, place of residence, income, and social-economic status [29]. From an examiner perspective, annual gynecologic cancer screening has facilitated regular contact with examinees. In general, women are invited by their gynecologists for the examination. The cytologic screening time interval depends on the doctor's personal judgment [30]. If he feels that the test will benefit their patients, the likelihood of performing the test increases. Some systemic review found a positive correlation of educational level, financial status, and an awareness of the mortality rates associated gynecological cancer with gynecological cancer attendance [26, 31, 32]. The level of knowledge and attitude toward health check-up are related to multiple factors such

Uterine cancer, in particular cervical cancer, is preventable. More than half of the women diagnosed with cervical cancer have not attended screening in the past 3 years. A community-based screening strategy is one of the greatest success stories in cancer prevention, and widespread

imaging examination may prove useful in detecting early stage cases [20–22, 25].

50 Cervical Cancer - Screening, Treatment and Prevention - Universal Protocols for Ultimate Control

ductive health services among young adolescence to postmenopausal.

as ethnicity, place of residence, income, and social-economic status [33–37].

**5. Discussion**

**4. Gynecological cancer screening intervals**

Ningen Dock check-ups provide an occasion to realize preventive medicine. An important aim of gynecological health check-up is to provide support in improving the risk factors that accelerate the risk of outbreak of a malignant disease at an early stage, before subjective symptoms become apparent. Additionally, meticulous educational guidance is provided to match individual living patterns, education level, and ways of thinking. Ningen Dock can also conceive of time in the future when more appropriate and effective educational advice could be continuously provided according to a participant cultural background and lifestyle habits, via collaboration with health-related public services.

Qualitative evaluation of Ningen Dock Facilities consists of documentation and an inspection. These are administration of the facility, satisfaction and safety of examinees, and quality of check-up and follow-up [1]. Recently, the usefulness of Ningen Dock has greatly increased not only in the primary, but also in the secondary prevention of non-communicable diseases due to advances in diagnostic medical technology and therapeutic medicine. However, one of the problems is that relatively large numbers of Ningen Dock examinees who require a second, more detailed examination do not have the examination that has been recommended. For instance, only 61% of the Ningen Dock examinees who required total colon fiberscope as a second, detailed examination due to a positive fecal occult blood test underwent it. Similar tendencies were recognized for almost all Ningen Dock examinations [11]. The reason why Ningen Dock examinees who need second, more detailed examinations do not have them may be that most of them do not understand the importance of such examinations for the early detection of non-communicable diseases and their risk factors because we do not adequately explain the need for more detailed examinations to examinees. Therefore, better education of examinees may be urgently needed in order to further increase the usefulness of Ningen Dock.

In Japan, there are also free physical check-up programs of cancer screening, by which asymptomatic participants undergo a medical examination at public expense. Takagi et al. [43] reported similar data using records of the public expense-covered free examination, and suggested that active gynecologic check-up and adequate follow-up programs even against symptom-free population can reduce in the probability of malignant disease development. Their findings from representative population of high-attitude toward screening, but non-high income, may give new insight into the terms of public health.

The present data are from subject to the limitations of any analysis of self-covered health check-up survey data from participants of Ningen Dock in Japan. Although data are weighted to reflect the Japanese population, the extent to which results are generalizable is no known. Future studies, extended to non-Asian, should attempt to oversample racial minorities and include a detailed assessment of gynecologic cancer screening history and follow-up treatment.

Women attitudes and beliefs related to screening frequency may differ if they reflected truly informed preference and may be related to less screening. The present chapter introduced the extremely low positive gynecology cancer screening incidence in Ningen Dock participants, providing the active strategy in the gynecological cancer screening practices of the lower screening attendance in Japan. However, strategies may be needed to encourage examiners to adopt recommended screening intervals and to educate women about the reasoning behind less-than-annual testing, including explicit discussions about the meaningless and potential harms associated with excess screening.

[5] Anttila A, Ronco G, Clifford G, Bray F, Hakama M, Arbyn M, et al. Cervical cancer screening programmes and policies in 18 European countries. British Journal of Cancer.

Great Role in Gynecological Cancer Prophylaxis of a Unique Health Check-Up Institute, Ningen…

http://dx.doi.org/10.5772/intechopen.72142

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[6] Bray F, Loos A, McCarron P, Weiderpass E, Arbyn M, Møller H, et al. Trends in cervical squamous cell carcinoma incidence in 13 European countries: Changing risk and the effects of screening. Cancer Epidemiology, Biomarkers and Prevention. 2005;**14**:677-686.

[7] Greenlee R, Hill-Harmon M, Murray T, Thun M. Cancer statistics, 2001. CA: A Cancer

[8] Hakama M, Coleman M, Alexe D, Auvinen A. Cancer screening: Evidence and practice in Europe 2008. European Journal of Cancer. 2008;**44**:1404-1413. DOI: 10.1016/j.ejca.2008.02.013

[9] Johannesson G, Geirsson G, Day N, Tulinius H. Screening for cancer of the uterine cervix in Iceland 1965-1978. Acta Obstetricia et Gynecologica Scandinavica. 1982;**61**:199-203.

[10] Mount S, Papillo J. A study of 10,296 pediatric and adolescent Papanicolaou smear diagnoses in northern New England. Pediatrics. 1999;**103**:539-545. DOI: 10.1542/peds.103.3.539

[11] Hirohara S. The annual report of totaling of questionnaires to accredited Ningen Dock

[12] Muñoz N, Bosch F, de Sanjosé S, Herrero R, Castellsagué X, Shah K, et al. Epidemiologic classification of human papillomavirus types associated with cervical cancer. New

[13] Rocha-Zavaleta L, Yescas G, Cru zR, Cruz-Talonia F. Human papillomavirus infection and cervical ectopy. International Journal of Gynaecology and Obstetrics. 2004;**85**:259-

[14] Tachezy R, Saláková M, Hamsíková E, Kanka J, Havránková A, Vonka V. Prospective study on cervical neoplasia: Presence of HPV DNA in cytological smears precedes the development of cervical neoplastic lesions. Sex Transmited Infection. 2003;**79**:191-196.

[15] Baseman J, Koutsky L. The epidemiology of human papillomavirus infections. Journal of Clinical Virology. 2005;**32**(Suppl 1):S16-S24. DOI: 10.1016/j.jcv.2004.12.008

[16] Clavel C, Masure M, Bory J, Putaud I, Mangeonjean C, Lorenzato M. Human papillomavirus testing in primary screening for the detection of high-grade cervical lesions: A study of 7932 women. British Jounal of Cancer. 2001;**84**:1616-1623. DOI: 10.1054/bjoc.2001.1845

[17] Levy B. Modern management of uterine fibroids. Acta Obstetricia et Gynecologica

[18] Parker W. Uterine myomas: Management. Fertility and Sterility. 2007;**88**:255-271. DOI:

[19] Sankaran S, Manyonda I. Medical management of fibroids. Best Practice & Research. Clinical Obstetrics & Gynaecology. 2008;**22**:655-676. DOI: 10.1016/j.bpobgyn.2008.03.001

Scandinavica. 2008;**87**:812-823. DOI: 10.1080/00016340802146912

England Journal of Medicine. 2003;**348**:518-527. DOI:10.1056/NEJMoa021641

Journal for Clinicians. 2001;**51**:15-136. DOI: 10.3322/canjclin.51.1.15

facilities nationwide in Japan. Ningen Dock. 2009;**23**:199-207

2004;**91**:935-941. DOI: 10.1038/sj.bjc.6602069

DOI: 10.1158/1055-9965.EPI-04-0569

DOI: 10.3109/00016348209156556

266. DOI: 10.1016/j.ijgo.2003.10.002

DOI: 10.1136/sti.79.3.191

10.1016/j.fertnstert.2007.06.044
