Cervical screening: time to change the policy.
1. 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. 2. 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. 3. 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. 4. 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. 5. If consensus is not reached within the profession, an evidence-based decision may need to be made at the political level.
Dickinson
James A
JA
Department of Community and Family Medicine, The Chinese University of Hong Kong, 4/F, School of Public Health, Prince of Wales Hospital, Sha Tin, New Territories, Hong Kong. jad@cuhk.edu.hk
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001315:Australia; D019317:Evidence-Based Medicine; D005260:Female; D006291:Health Policy / Q000639:trends; D006801:Humans; D065006:Papanicolaou Test; D013997:Time Factors; D014626:Vaginal Smears / Q000592:standards*