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Thursday, December 17, 1998 Published at 13:59 GMT


Screening cuts deaths

The screening programme is estimated to prevent 3,900 deaths a year

Death rates from cervical cancer in the UK are falling by 7% a year as a result of the NHS Cervical Screening Programme, according to its first ever annual report.

But new screening techniques could improve the reliability of cervical smears sent for testing and reduce the number of times women are recalled for a second sample.

Baroness Hayman: "One of the biggest and best programmes in the world"
The screening programme has been in existence for 10 years. Figures from the Imperial Cancer Research Fund suggest that it prevents up to 3,900 cancers each year.

The report said that the rates of cancer would be 50% greater if there was no screening programme, and that regular screening prevents 80-90% of cervical cancer.

However, the programme has been blighted by a number of highly publicised cases where errors in the screening process have led to recalls for thousands of women.

The report also found that a high average participation in the scheme disguised "pockets with low levels of acceptance" of it.

In particular, those who move around a lot, such as homeless people, were difficult to track on the computerised recall system.

It also found that the number of "inadequate" smears, where the sample taken by a doctor is not fit for analysis in the laboratory, was on the rise.

A new technology, already in use in the US could improve the usability of cervical smears and perhaps lead to accurate automated screening.


It found that deaths from cervical cancer had fallen from 1,369 in 1994 to 1,222 in 1997.

[ image: Current methods involve a direct smear onto a slide]
Current methods involve a direct smear onto a slide
Between 1988, when a computerised system was set up to automatically remind women they were due for a smear test, and 1997, deaths from cervical cancer dropped from 6.1 per 100,000 women to 3.7.

Incidence of the disease fell from 15.9 cases per 100,000 in 1988 to 10.3 in 1995, the last year for which figures are available.

The programme aims to screen 80% of eligible women, and since it began in 1988 it has risen from 22% to a steady 85% over the past three years.

Lords Health Minister Baroness Hayman was at the launch of the review.

She said: "Despite the successes of the programme there have also been some isolated problems that have attracted a great deal of adverse media coverage.

"However, following these failures the government took swift action to address shortcomings in the cervical screening programme."

The measures include "the biggest shake-up" in the programme's history. This involves:

  • Regional public health directors drawing up action plans to tackle areas of low take-up;
  • They will also have to make formal annual reports to the NHS Executive on the performance of the programme in their region;
  • A quality assurance director has been appointed for every region;
  • The introduction of resource packs to improve training of smear testers;
  • Compulsory accreditation of laboratories.

Julietta Patnick, national co-ordinator of the programme, said one reason for the increased number of inadequate smears was that laboratory staff were being more pick about the quality of sample they used.

Another is that the technique used to take samples from the cervix is partially flawed.

Dr Phemie McGoogan, clinical director of pathology at Edinburgh Royal Infirmary, lectures on new technologies in this area.


At the launch of the report she outlined the differences between the Pap smear, which is currently in use in the UK, and liquid-based cytology, which is used in the US.

Pap smears are where a sample is take from the cervix, and then smeared on to a slide for examination.

[ image: Some techniques produce an obscured sample]
Some techniques produce an obscured sample
This process often collects blood and inflammatory tissue that can obscure the important cells pathologists need to examine.

Also, up to 90% of the sample collected is usually discarded, meaning that indications of disease may not even be on the slide sent for screening.

Liquid-based cytology is where the whole sample is placed in solution and transferred to the laboratory. There it is prepared on a slide.

The resulting slide is free of blood and inflammatory tissue and offers a more representative sample of cells, Dr McGoogan said.

The newer technique could significantly reduce the number of inadequate smears - from 8% to 1-2% she estimated - and thus reduce the anxiety women face when called for a second smear.


However, the procedure would require "six weeks to six months" of re-training for laboratory staff depending on their current level competence, Dr McGoogan said, and the process itself costs more.

But the method allows screens for other diseases to be performed, and is likely to be more reliable. It will also make it easier for screeners to identify abnormal cells.

These are elements that can justify the cost, she said.

[ image: Othe rmethods make the cells far more clearly visible]
Othe rmethods make the cells far more clearly visible
Dr McGoogan said: "I would like to see pilots to examine the cost-effectiveness of introducing this technology into the programme."

Baroness Hayman said that the government "would be very sympathetic to a pilot proposal".

Research currently under way in Edinburgh is expected to produce findings in 12-15 months' time.

The Institute of Health Services Management said the review's results were good news but the government must not rest on its laurels.

Suzanne Tyler, deputy director of the institute, said: "The government cannot afford to be complacent as there have been shortcomings in the past.

"While screening cannot guarantee a 100% success rate the government must not hold back on constantly improving the programme."

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