Cervical cytology and histology in the context of a screening programme

Abstract

In the UK, the national cervical cancer screening programme is probably the most established, robust and rigorous of all screening programmes that has evolved over 25 years. It has seen a multitude of changes based on evidence obtained from a vast amount of research and observations, as well as from advances in technology. This success has led to a definite impact on cervical cancer incidence with reduced mortality and morbidity related to cervical cancer. More recently, the changes introduced to the programme have been exponential and in the UK we are at the brink of a new direction and a new style of provision of the screening programme. Throughout the years, there has been a continued effort to understand morphological aspects of the cytology and histology in cervical neoplasia and many new entities have been recognised or variations of known entities realised. The intricate measures to ensure quality in the screening programme have led to close working relationships between cytologists, histopathologists, colposcopists, and now, molecular biologists. The UK cervical cancer screening programme (CCsP) is likely to change significantly in the next few years, and although reduced in quantity, cytology will still remain an important aspect of it. The importance of histopathology is unlikely to change, but more onus will be placed on the molecular biologists and colposcopists. In order to discuss and understand the importance of cytology and histology in the cervical screening programme and the absolute requirement of correlation between the two, it is important first to appreciate how the UK CCsP has evolved and how it has taken with it the evolution of new technologies in cytology leading to improved correlation between histology and cytology and quality assurance with obvious benefits to the patient.