Abstract
The National Health Service Cervical Screening Programme in England and Wales has been a significant factor in the fall of mortality in cervical cancer in England and Wales. This improvement is likely to reach a plateau. There appear to be two approaches to combat this. Firstly, and most importantly, coverage rates need to be improved. Secondly, the method of screening can be improved. This review article aims to look at changes that are currently being considered in order to further improve the Programme, whilst keeping it as cost-effective as possible. From a technical point of view, these include the introduction of liquid-based cytology and human papilloma virus (HPV) testing as well as other new technologies. Also discussed are the issues of the management of mildly dyskaryotic smears by cytological surveillance or immediate colposcopy, the auditing of all previous smears of patients with cancer of the cervix, and a possible change in the nomenclature used in England and Wales towards the Bethesda system (TBS). The psychological morbidity of screening is also considered as reducing this may improve coverage.
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