Improving the effectiveness of cervical cancer screening.

A review of 100 cases of invasive cervical cancer was designed to assess what changes in cervical screening services might be most effective in reducing mortality. In 68 cases there had apparently never been screening: no system of individual invitation existed for unscreened women. In 10 cases the last smear was reported as normal over five years earlier: a five-year recall system existed but was inefficient. In 13 cases suspicious cervical smear reports had not been followed up adequately. Two cases might have been diagnosed earlier, in spite of ;normal or inflammatory' smears, if the symptoms had been fully elicited. For the remaining seven cases one or more smear was reported as normal within five years of diagnosis of invasive cancer. Overall, 15 cases might have been picked up earlier if suitable opportunities for screening which did arise had been exploited. It was concluded that a substantial proportion of these 100 women might have received treatment at an earlier stage solely by the rigorous implementation of the present screening policy.