Cervical screening: time to change the policy

Abstract

In 1991, the “organised approach to preventing cancer of the cervix” recommended Pap smears every two years for women aged 18–70 years who have ever been sexually active. The two‐year interval was a compromise step towards the scientifically supported three‐year interval, as many influential groups were strongly attached to annual screening. When other components of the organised approach were in place, the policy was to be reviewed. Since the safeguards in the “organised approach” have been proven effective, it is appropriate to change the policy to recommend a three‐year interval. Increasing the interval would allow more resources to be allocated to enrolling women currently underscreened and to evaluating and improving the program. The age of commencing smears could also be reconsidered to reflect the balance of potential benefits and harm in young women, for whom cancer is very rare but follow‐up investigation common. If consensus is not reached within the profession, an evidence‐based decision may need to be made at the political level.

The cost‐effectiveness of cervical screening in Australia: what is the impact of screening at different intervals or over a different age range?

“…Although regular screening using Pap tests is of proven efficacy, there is still debate about the optimum frequency and age range for screening programs 4,5 . This is partly a reflection of continuing scientific uncertainty about the biology of cervical cancer and the accuracy of the screening tests, but also, in some countries, the attachment of professional groups to particular screening intervals.…”

“…This is partly a reflection of continuing scientific uncertainty about the biology of cervical cancer and the accuracy of the screening tests, but also, in some countries, the attachment of professional groups to particular screening intervals. Screening policies in Western countries range from those recommending annual screening (some United States professional organisations) to those with three‐ or five‐yearly recommended screening intervals (most European countries and some Canadian provinces) 5 . Australia, with a two‐yearly recommended screening interval (since 1990), is at the more frequent end of the spectrum of existing national programs.…”

“…3 Although regular screening using Pap tests is of proven efficacy, there is still debate about the optimum frequency and age range for screening programs. 4,5 This is partly a reflection of continuing scientific uncertainty about the biology of cervical cancer and the accuracy of the screening tests, but also, in some countries, the attachment of professional groups to particular screening intervals. Screening policies in Western countries range from those recommending annual screening (some United States professional organisations) to those with three-or five-yearly recommended screening intervals (most European countries and some Canadian provinces).…”

Cervical cancer in Australia and the United Kingdom: comparison of screening policy and uptake, and cancer incidence and mortality

“…The choice of a 2‐yearly screening interval in Australia was made in the context of the IARC review, while including a safety margin. This was to take into account that Pap test registers were not yet configured in all states, and that full quality assurance measures on all aspects of cervical smear testing, from the smear‐taker to the laboratory, were not yet in place 3 . The Australian National Cervical Screening Program, therefore, recommends cervical screening more frequently and across a wider age range than many screening programs in developed countries 3 …”

Cervical screening: time to change the policy

“…To the Editor : I read with interest the article on cervical screening by Dickinson 1 . Cervical screening has been the most successful public health measure introduced for the prevention of cancer, and the Pap test has been highly effective in reducing cervical cancer mortality and morbidity.…”