1. Cervical Screening

2. No change in death rate since 1968 USA and Finland have reduced their death rates by 50% in 10 years Does it satisfy Wilsons Criteria?

3. Wilsons Criteria Condition 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