Cervical Cancer Screening zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHG 2325 129. Schydlower M, Greenberg H, Patterson PH. Adolescents with abnormal cervical cytology. Clin Pediat 1981,20,723-726. 130. Roberts AD, Denholm RB, Cordiner JW. Cervical intraepithelial neoplasia in postmenopausal women with negative cervical cytology. Br MedJ 1985,290,281. 131. Wheat ME, Mandelblatt ]S, zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA Kunitz G. Pap smear screening in women 65 and older. J Am Genist Sot 1988,36,827-830. 132. Wadsworth A, Gilbert R. Approval of laboratories for surgical pathology in New York State. Am J Pub1 Health 1934, 24, 1035-1038. 133. Collins DN, Patacsil DP. Proficiency testing in cytology in New York. Actu Cy~l1986,30,633-642. 134. Rube IF. Experience in managing a large-scale rescreening of Papanicolaou smears and the pros and cons of measuring pro- ficiency with visual and written examinations. Acra Cywll989,33, 479-483. 135. Thompson DW. Canadian experience in cytology proficiency testing. Acta Cytoll989,33,484-%86. 136. Wied GL, Bartels PH, Bibbo M, Keebler CM. Frequency and reliability of diagnostic cytology of the female genital tract. Acta Cywll981,25,54~549. 137. Coppleson LW, Brown B. Estimation of the screening error rate from the observed detection rates in repated cervical cytology. Am J Obstet Gym01 1974,119,953-958. 138. Ohrt DK. The intraepithelial lesion: a spectrum of problems. JAMA 1989,262,944-945. 139. National Cancer Institute Workshop. The 1988 Bethesda system for reporting cervical/vaginal cytological diagnoses. JAMA 1989, 262,931-934. zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPON Acknowledgements-I am indebted to Dr David Axelrod for his encouragement, to Drs Lawrence Sturman and Charles Lawrence for their thoughtful comments, and to MS Kathleen Cavanagh for expert assistance in the preparation of the manuscript. Ewf Cancn, Vol. 29A, No. 16, $Q. 2325-2330,1993. Ptiwd in Great Btiain 0959-804919356.00 + 0.w Pngamon PressLd zyxwvutsr Commission of the European Communities “Europe Against Cancer” Programme European School of Oncology Advisory Report Cancer Treatment in the Elderly S. Monfardini, M. Aapro, L. Fermcci, V. Zagonel, P. Scalliet and I. Fe&man Within the EC approximately one million cases of cancer are diagnosed every year. At present, more than 55% of cancers occur in subjects aged over 65 years. There has been little clinical attention to the problem of neoplasia in the elderly. They are not receiving the same standard of specialised oncological care as younger patients. Other diseases (co-morbidity conditions) associated with cancer, and influencing its treatment and outcomes are not being properly considered. Information on surgery, radiotherapy and chemotherapy in younger patients exists for all cancers and could be adapted for the elderly. Controversial aspects of neoplasia in the elderly concern the intensity of chemotherapy, extent of surgery and the relative roles of special&d cancer centres, community hospitals and primary care providers. Future research should aim to replace subjective opinions on presence of frailty with objective instruments such as the multidimensional geriatric assessment scale. New trials could then seek to improve treatment in well-defined populations in terms of both efficacy and quality of life. Funding priorities should firstly consider that clinical trials for tumours in the ekierly must be organised from cancer institutes and specialised referral centres in collaboration with geriatricians, primary care and community hospital physicians. Continuing education of doctors should be supported. A document such as this with appropriate mod&cations might be used as an initial message on neoplasia in the elderly to be published for information to clinicians and the public throughout Europe. Specific measures of quality assurance need financial support to evaluate the improvements in patterns of care. The 10 points of the ‘Europe Against Cancer Guidelines’ need re- emphasising. zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA EurJ Cancer, Vol. 29A, No. 16, pp. 2325-2330,1993. INTRODUCTION underline that chronological age is not a reliable indicator of This document has been prepared for the EC Medical Com- frailty and thus cannot be used for selecting the most appropriate mission to provide information on the problem of cancer in therapeutic strategy for cancer in the elderly. Concomitantly, the elderly, with present and future needs for treatment and this report has been conceived for parallel dissemination to education, in order for the EC to provide recommendations to European public health officers and possibly to all medical the Member States. The main object of this document is to doctors.