Screening and logical cytology – a review

Abstract

Screening is intuitively a good thing in that it is a rational attempt to limit the effects of a condition. Early detection, when interventions can cure or change the course of the disease is an attractive notion but the screening process must be effective. There are various riders to an effective screening process and some of these are being critically reviewed in the gynaecological domain. Cervical cytology has long been held up as the gold standard of screening programmes but with the new understanding of the natural history of Human Papillomavirus and its involvement in cervical cancer, the place and effectiveness of cytology is being reviewed. The role of vaccines against the oncogenic strains of the Human Papillomavirus provide fresh hope of reducing the burden of the disease but effects they will have on screening for the virus or the cytological changes it causes bear careful scrutiny. Other cancers in women – ovarian and breast – do have screening programmes but these are also being reviewed critically and found to be wanting.

Key words: Screening; Cervical cytology; Human Papillomavirus; HPV vaccines