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: Screening 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