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 Wilsons Criteria?

3
Wilsons 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