The abnormal cervical smear

Cervical screening aims to reduce the incidence of and death rate from cervical cancer. The death rate is currently dropping by 7% per annum in the UK owing to a cervical screening programme testing women every 3-5 years up to 65 years of age. Human papillomavirus infection appears to be intimately involved in the development of cervical dysplasia and progression to carcinoma. The management of abnormal smears reflects this relationship. Colposcopy as a secondary screen is used to investigate defined cytological abnormalities and to treat high-grade preinvasive or early invasive disease. Thereafter, more frequent cervical smears are required to detect treatment failure or recurrent dysplasia. Various aspects of the screening programme are integrated by quality assurance surveillance procedures, ensuring that all disciplines perform to appropriate and acceptable standards. Liquid-based cytology is being introduced, and human papillomavirus testing is currently undergoing evaluation.