Cervical Screening

1. Cervical Screening

2. Cervical Screening • No change in death rate since 1968 • USA and Finland have reduced their death rates by 50% in 10 years • Does it satisfy Wilson’s Criteria?

3. Wilson’s Criteria • Condition must be: • common • important • diagnosable • have a latent interval • Screening must be: • cheap and simple • continuous • targeted towards a high risk group

4. High Risk Groups • Low socio-economic class • Early age onset of sexual intercourse • Early age first pregnancy • Multiple sexual partners • Frequent pregnancies • History of sexually transmitted diseases

5. Limitations of the Test • 10% false negatives • 10% false positives • Relies on squamocolumnar junctional sample

6. Limitations of the Individual • Poor sampling and fixative delay • Menstruation • Pregnancy • COC • IUDs • Polyps

7. Limitations of the NHS • 5 year payments, professionals recommend 3 yearly interval • Inadequate resources • Inverse care principle • Inadequate organisations

8. Ellman & Chamberlain 1984 Review of 100 Cervical Cancer Deaths • 68 never screened • 10 no smear for 5 years • 13 positive smears not followed up • 91 potentially preventable