Pap Smear Method Research Articles

Comparison of conventional Pap smear and liquid-based cytology: A study of cervical cancer screening at a tertiary care center in Bihar.

Cervical cancer is the fourth leading cause of cancer in women in the world and it is the second most common cancer in women 15-44 years of age. Strict implementation of screening programs has led to a large decrease in cervical cancer incidence and mortality in the developed countries. In contrast, cervical cancer remains largely uncontrolled in high-risk developing countries because of ineffective or no screening programs. Conventional Pap smear method has been the mainstay of most of the screening programs for many decades. However, this technique is not without limitations, and the sensitivity and specificity of cervical cytology are relatively low. To overcome the limitations of conventional Pap smear (CPS), liquid-based cytology (LBC) was introduced in 1990s as a better tool for processing cervical samples. This study was undertaken to compare CPS with liquid-based methods, to assess the effectiveness and feasibility of LBC over CPS in our setting, and also to evaluate the prevalence of human papillomavirus (HPV) in our population. This study was conducted in Gynecological Oncology Unit of Regional Cancer Center at Indira Gandhi Institute of Medical Sciences, Patna, Bihar. About 310 women were enrolled in this study and the sample was taken for both conventional cytology and LBC. The smears were studied in detail and were interpreted as per the Bethesda system of reporting Pap smears. The results were compared and analyzed statistically. Unsatisfactory smears were more commonly reported by conventional method (7.1%) than with liquid-based method (1.61%), and this difference is statistically significant. There was no difference in the detection of epithelial cell abnormalities using both the methods. HPV DNA for high-risk oncogenic strains (16 and 18) was detected in 6.45% of women in this study. LBC has been found to be more superior to conventional smears only with respect to lesser number of unsatisfactory smears, but considering the economic implications of LBC, conventional Pap is more feasible in our setting.

Profile of utero-cervical lesions in peri- & post-menopausal women in Kumaon Region of Uttarakhand: An Institutional study

INTRODUCTION PAP smear is an important tool which compliment histopathology in detection of various cervical lesions. Since last few decades, it is becoming easy and cost-effective way for early detection of pre-cancerous and cancerous cervical lesions. AIMS/OBJECTIVES: The objective of this study is to evaluate the utero-cervical lesions in peri- & post-menopausal age group by Pap smear method; to study the distribution of cervical lesions and to correlate cytology with histopathology wherever available. MATERIALS AND METHODS: The study was conducted at pathology department of GMC, HALDWANI. It comprised of 324 cases of PAP smear of women with complaints pertaining to cervix over a period of two years. . PAP smear results were reported according to 'The Bethesda system' (TBS), followed by cervical biopsy and surgically resected specimens, wherever available. RESULTS: Total 324 cases were evaluated on pap smear cytology. The most of the cases comprised of peri and post menopausal age group (141women,43.52%) while only 16 women (4.96%) are over 65 years. Most common symptom was lower abdominal pain (100 cases; 30.87%). The cervical lesions were categorized as: 14 (4.32%) cases unsatisfactory, 231 (71.30%) cases benign /inflammatory, 60 (18.52%) cases normal, 15 (4.63%) cases of pre-malignant and 4 (1.23%) cases of malignant category. On histopathological examination, maximum 59 (68.61%) cases were inflammatory, 7 (8.14%) cases were pre-malignant and 20 (23.25%) cases were malignant. CONCLUSION: Our study concluded that the pap smear examination is a useful technique to find the cause of cervical lesions. It is easy to perform, minimally invasive, outdoor procedure that gives quick results and should be followed at all the centers.

Cervical Cancer Screening Program – A Camp Based Cross Sectional Study Among Rural Women in North Kerala

Cervical cancer is ranked as the most frequent cancer in women in India and still remains a leading cause of cancer deaths because of high HPV infection rates and lack of comprehensive cervical Pap smear testing of susceptible women. There has been a regular campaign against cervical cancer for 30 years in India, but impact on the morbidity and mortality has been low, with India ranking fourth worldwide. A key challenge for cancer programs is encouraging women in the 30-55 year age group at highest risk for treatable, precancerous lesions, to seek pap smear screening camps. To increase attendance it is important to work in the community by approaching local women's groups and with their help increasing awareness, knowledge and accessibility of screening among women. In this study the investigators made an effort to increase camp attendance by involving women’s groups. We assessed the effect of involvement of women groups in comparison to previous camps, the awareness, attitude and practice of the disease, and its prevention, and the HPV vaccine among the women and finally studied the Pap smear results. A camp based cross sectional study was done in Karindalam village to assess pap smear tests, knowledge, attitude and practice regarding cancer cervix and its screening method. Community level women volunteers were used to mobilise women for the camp. Quantitative data was collected through face to face interview using a pre tested questionnaire and the pap smear test done. Analysis was done with descriptive statistics using epi info. There were 319 women who attended the camp. Out of these 99.7% were ever married. In our studied population 55% of the women were married before 20 years of age and 36% had their first child before 20 years of age. Fifty percent studied up to 10th grade and around 50% belonged to the lower class. Majority of the women had inadequate knowledge about the disease symptoms (52.7%), risk factors (76%), preventive measures (65.5%), Pap smear method (91%) and HPV vaccine (8.4%). Reasons for not doing a Pap smear test so far were inadequate knowledge about the disease and test, fear of procedure and result, non availability of the test locally, being non symptomatic, and cultural factors. The Pap smear tests identified 2 (0.6%) women with high intra epithelial lesions, 4 (1.2%), endocervicitis and 3 (1%) with bacterial vaginosisand adequate follow up was offered. The government of India has to respond to the need of the hour and strengthen information, education and communication efforts on cervical cancer along with providing widespread screening facilities.

Reasearch progress of cervical cancer screening

As to clarify the cause of cervical cancer, early normative and effective screening can decrease the incidence and mortality of precancerous cervical lesions and cervical cancer. At present the main methods for cervical cancer screening are pap smear method, acetic acid shading to naked eye observation, iodine staining to the naked eye observation, liquid based cytology and human papillomavirus DNA testing methods. Screening techniques and strategies are different in different areas and countries because of unba-lanced economic development. Key words: Uterine cervical neoplasms; Tumor markers, biological; Human papillomavirus

Investigation of human papillomavirus prevalence in women in Eskişehir, Turkey by Pap smear, hybrid capture 2 test and consensus real-time polymerase chain reaction and typing with pyrosequencing method

Human papillomavirus (HPV) infections have a broad range of clinical spectrum from subclinical or asymptomatic infection to anogenital carcinoma. The detection of HPV-DNA and determination of the risk groups in cervical cancer (CC) screening is very important because CC is considered to be a preventable illness which is the third most common cancer type of women in the world. The aims of this study were to investigate the presence of HPV-DNA in women by two different molecular methods and to compare their results together with the results of cytology, in Eskişehir, Central Anatolia, Turkey. A total of 1081 women aged between 30-65 years, who applied to Eskişehir Early Diagnosis, Screening and Training of Cancer Center (KETEM) for screening were included in the study. Three separate cervical samples were collected simultaneously from the participants for cytologic examination and molecular studies. In the first step of the study, all cervical samples were investigated for the presence of HPV-DNA by Hybrid Capture 2 (HC2; Qiagen, Germany) method. In the second part of the study, consensus real-time polymerase chain reaction (RT-PCR) (Takara Bio Inc., Japan) was performed in 152 samples which included HC2 positive and randomly selected negative samples, and then the HPV genotypes were detected by using a commercial kit based on pyrosequencing method (Diatech Pharmacogenetics S.R.L, Italy). In the first part of the study, HC2 test was found positive in 3% (32/1081) of the women, while in 4.4% (47/1081) Pap smear was positive alone or with HC2 test. Five (0.5%) samples yielded positive results with both of the methods, and four of them were positive for high risk HPV types. Cytology results were negative in 19 out of 23 (23/1081, 2.1%) samples that were reported as high risk HPV by HC2 test. On the other hand, 42 (42/1081, 3.9%) samples that were positive by cytology yielded negative results by HC2 test. In the second part of the study, 32 (21.1%) of 152 selected samples were positive by HC2 test, 40 (26.3%) were positive by Pap smear, and 53 (34.9%) were positive by consensus RT-PCR. All of the 32 samples that were positive by HC2 were also positive by RT-PCR, however 21 samples that were positive by RT-PCR were negative by HC2 test. Among 40 samples that were positive (abnormal) by Pap smear, HPV-DNA was positive in nine (22.5%) by RT-PCR and in five (12.5%) by HC2 test, but HPV-DNA was not detected in 31 (77.5%) samples by both of the tests. Genotyping of the strains could be performed in 44 samples, and the most common type detected was HPV type 16 (n=15, 34.1%), followed by type 90 (n=11, 25%) and type 18 (n= 4, 9.1%). In our study, the sensitivity, specificity, positive and negative predictive values of Pap smear method were estimated as 16.1%, 96%, 10.6% and 97.5%, respectively, based on the HC2 results which was approved by U.S. Food and Drug Administration (FDA). In addition, a significant degree of concordance was detected between HC2 and concensus RT-PCR methods (Cohen's kappa: 0.665). In conclusion, regarding the insufficient number of cytopathologists in our country and according to the recommendations of American Society for Colposcopy and Cervical Pathology (ASCCP) and FDA, it was once again demonstrated that, the implementation of molecular diagnostic methods in addition to the Pap smear for effective screening of CC are needed.

Conventional pap (papanicoloau) smear cytology in primary screening of cervical lesions & its comparison with manual liquid based cytology

Background: Conventional pap smear (CPS) examination has been the mainstay for early detection of cervical cancer. However, its widespread use has not been possible due to the inherent limitations, like presence of obscuring blood and inflammation, reducing its sensitivity considerably. Aims & Objectives: The study was performed to compare the efficacy of Manual Liquid based Cytology (MLBC) with CPS and to find out whether MLBC can be established for routine use in our laboratory setup. Materials & Methods: Cervical smears were collected by the gynaecologist using Ayre’s spatula and cytobrush for the conventional Pap smear method and are suspended in a liquid medium for manual liquid based cytology technique. In this study, cervical screening was performed in 481 cases, all were married women of reproductive age group who visited Department of Obstetrics and Gynaecology over a period of one year from July 2014 to June 2015. Slides were examined for cytomorphological parameters. The details regarding cell size, cytoplasmic and nuclear details were studied for making the diagnosis. Result: The sensitivity of CPS in detecting cervical lesions is 95% and by MLBC is 50% while the specificity was 86% with CPS technique and 69% by MLBC technique. Conclusion: The cellular features are better in MLBC as compared to CPS and also background is more clear in MLBC as there was no obscuration by RBCs or inflammatory cells while in CPS, the background is dirty due to the presence of RBCs, necrosis and inflammation. Keywords: Conventional Pap Smear, Manual Liquid based Cytology, Pap smear, Cervical cytology

Comparing the results of Pap smear and Direct Visual Inspection (DVI) with 5% acetic acid in cervical cancer screening.

Background:Cervical cancer is the most second common cancer among Iranian women. This study was carried out to compare the results of Pap smear method and Direct Visual Inspection (DVI) with 5% acetic acid in cervical cancer screening in Tabriz, Iran.Material and Methods:This cross-sectional study was carried out in Alzahra Therapeutic-Educational Centre, Tabriz, Iran in 2013 on 1000 women. First, Pap smear was done for all women, and then the cervix exposed with 5% acetic acid by cotton swab for 30 seconds and observed under adequate light. At the end, women with abnormal results in Pap smear or DVI method were referred to colposcopy and biopsy. Test's sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), LR+, LR- and confidence interval (CI) were determined (P < 0.05).Results:Nine-hundred and seventy-four (94.7%) cases were normal and had no abnormal findings and 26 (2.6%) participants had positive results in Pap smear or DVI test. Twelve women had abnormal Pap smear (nine women with atypical squamous cells of undetermined significance, ASCUS, three women with dysplasia, atypical endocervical, and low-grade squamous intraepithelial lesion, LSIL results) and 14 women had positive DVI (four women with human papillomavirus, HPV or koilocyte,) and one women with abnormality in both method had carcinoma in biopsy that referred to oncologist. In this study the sensitivity, specificity, PPV and NPV for DVI were 71.4%, 50%, 35.7%, and 81.8% respectively in comparison with 14.3%, 50%, 10%, and 60% for Pap smear.Conclusion:As the DVI method has higher sensitivity and positive predictive value than Pap smear, it could be used as a useful method beside the Pap smear.

P5.018 Improved Diagnosis of Non-Neoplastic Conditions of Cervix by Liquid Based Cytology, Cellbock in Comparison with Conventional Pap Smear Method

Background The Papanicolaou (Pap) smear is the most successful screening test for carcinoma of cervix, mainly as a result of its simplicity, low cost, low false-negative rate and its early detection of preneoplastic lesions. It is also used to diagnose several infectious agents that manifest with specific cytologic features. The diagnoses of candida, trichomonas, herpes simplex virus, HPV and bacterial vaginosis can be reliably rendered on Pap smears. Conventional pap smear (CPS) has its limitations. False negatives in CPS may be related to inadequate sampling, inadequate transfer of the sample onto the glass slide or deficiencies in the microscopic assessment of the slide. To overcome these problems, a new slide preparation method namely the Manual Liquid Based Cytology (MLBC) was introduced, where cells are uniformly dispersed by a membrane, from a suspension of cells in a polymer solution. MLBC helps in detecting number of infestations like Candida, Leptothrix, HPV with koilocytic atypia and bacterial vaginosis, as observed by many authors and us also. MLBC, which we are following is inexpensive, cost effective method which we have adapted and are comparing it with CPS for its adequacy and utility. The other advantages, is that the residual specimens can be used for ancillary testing like immunocytochemistry by cell block preparation. Results Number of cases of bacterial vaginosis diagnosed by CPS were 8, LBC 9 and cell block were zero. trichomonas were 4, by CPS and LBC,2by cell block., herpes was 1 by all three methods,inflammatory (NILM) cases were 22 by CPS,26 by LBC,12 by cell block. Inadequate smears were 5 by CPS, NIL by LBC,25 by cell block Conclusion CPS and LBC with cell block are useful methods in detection of non neoplastic conditions of cervix. LBC has increased the diagnostic accuracy by 13% in our study.

Sensitivity of a papanicolaou smear in the diagnosis of candida albicans infection of the cervix.

Background:Candida albicans infections of the cervix are not adequately diagnosed in Papanicolaou smears when compared with culture in Sabouraud dextrose agar.Methods:Cervical smears were collected from 1000, non-pregnant, asymptomatic women. The specimens were prepared using the Papanicolaou (Pap) smear method examined by microscopy and subsequently cultured in Sabouraud dextrose agar.Results:The overall incidences of C. albicans in cervical smears cultured in Sabouraud dextrose agar was 30.10%, while the incidence in the Pap smears was 7.60%, making the sensitivity of Pap smears for the diagnosis of C. albicans to be 25.25%. Mild, and some moderate, infections detectable in Sabouraud dextrose agar could not be detected in the Pap smear specimens. Vulnerability to C. albicans infection decreased with age, the highest infection rate being between 20 and 39 years of age while the least was between 60 and 69 years of age. Papanicolaou's method stained the nuclei, chromatin and nucleoli very well and enhanced differentiation between malignant and non-malignant cells. It also stained the cytoplasm and its contents such as keratin, vacuoles and granules and differentiated between acidophilic and basophilic materials. Non-cellular substances such as fibrin, crystals and pigments were also stained using this method. In addition, Papanicolaou's method also stained some fungal and bacterial species, but did not provide differential staining characteristics seen in Gram staining technique.Conclusions:Papanicolaou stain should not be used as an alternative to culture in the diagnosis of Candida albicans.

Clinical application of the SurePath liquid-based Pap test in cytological screening of bronchial brushing for the diagnosis of lung cancer

The SurePath liquid-based Pap test (LPT) is successfully and widely used to assess sputum cytology. This study aimed to compare the cytological findings and diagnostic sensitivity of LPT with those of the conventional Pap smear (CPS) method for diagnosing lung cancer. Bronchial brushing specimens from 204 patients diagnosed with lung cancer were studied. LPT slides showed decreased areas of cell monolayers, a clearer background and distinct, stereoscopic cytological features. The LPT had a significantly higher diagnostic sensitivity for lung cancer (71.6%) than the CPS method (57.8%, p < 0.05), particularly for small cell lung carcinoma and >2 cm lesions (p < 0.05). Combination of the LPT with the CPS method showed obviously higher diagnostic sensitivity for the detection of adenocarcinoma (63.6%), central lesions (85.0%) and >2 cm lesions (81.4%) compared with the CPS method alone (p < 0.05, p < 0.01). Thus, LPT is a useful and easily performed technique that can be widely applied, and is suitable for the early diagnosis of lung cancer.

The prevalence of cervical cytology abnormalities and human papillomavirus in women infected with the human immunodeficiency virus

IntroductionThe human papillomavirus (HPV) is the major etiologic agent in the development of cervical cancer and its natural history of infection is altered in persons infected with the human immunodeficiency virus (HIV). The prevalence of HPV infection and cervical dysplasia in the HIV sero-positive females in the Bahamas is not known. Finding out the prevalence would allow for the establishment of protocols to optimize total care of this population and help prevent morbidity and mortality related to cervical cancer.ObjectiveThe Objective of this study is to determine the prevalence of high risk HPV genotypes and the prevalence of cervical dysplasia in the HIV sero-positive females attending the Infectious Disease Clinic at the Princess Margaret Hospital, Nassau, Bahamas.MethodsOne hundred consecutive, consenting, non-pregnant, HIV-sero-positive females from the Infectious Disease Clinic at the Princess Margaret Hospital in Nassau, Bahamas were screened for high-risk HPV infections and cervical cytology abnormalities using liquid-based pap smear and signal amplification nucleic acid method for HPV detection. A questionnaire was also utilized to gather demographic information and obtain information on known risk factors associated with HPV infections such numbers of partners.ResultsThe prevalence of high-risk HPV was 67% and cervical abnormalities were noted in 44% of the study population. High-risk HPV types were more likely to be present in women with CD4+ cell counts less than 400 μl-1 and in women with cervical cytology abnormalities (97%). The most common cervical abnormality was low-grade squamous intraepithelial lesions.ConclusionFindings suggest that HIV-sero positive females should have HPV testing done as part of their normal gynecology evaluation and these patients should be encouraged and provisions be made for ease of access having regular PAP smears and HPV testing.

Efficacy of visual inspection of the cervix using acetic acid in cervical cancer screening: A comparison with cervical cytology

SummaryScreening programmes for the early detection of premalignant lesions of the cervix are expensive and technically difficult, especially in resource-challenged settings. There is a need for cheaper and equally effective alternative screening methods. This study compared the efficacy of visual inspection of the cervix using acetic acid (VIA) with the Pap smear method. A total of 186 subjects had a Pap smear followed by visual inspection of the cervix using 3 – 5% acetic acid with biopsies taken from suspicious acetowhite positive lesions. Cases of abnormal cytology were recalled for biopsies. A total of 150 subjects were negative for both tests; 30 (16.2%) were positive for VIA, while six were positive for both VIA and Pap smear. VIA detected one lesion missed by Pap smear on biopsy. The sensitivity of VIA was 100%, while that of Pap smear was 85.7%. The negative predictive value of VIA was 100%, while the positive predictive value was 20%. The sensitivity of VIA equals the reported rates for Pap smear. VIA is proposed as a credible alternative to Pap smear in resource-challenged settings.

Liquid-based cytology for cervical cancer screening

In multiple studies during the last decade, liquid-based cytology for cervical cancer screening has been shown to increase the detection rate for preneoplastic squamous intraepithelial lesions equal to or greater than the conventional Papanicolaou (Pap) smear method. Liquid-based collection and processing provide more representative cervical sampling than conventional smearing of the specimen on a glass slide. Currently, there are two test methodologies that are widely marketed and available to clinical laboratories, health systems and clinicians that undertake cervical cytology. The purpose of this article is to provide an overview of the methodology and performance of SurePath™ Liquid-Based Pap Test in cervical cytology screening. The SurePath liquid-based Pap test significantly reduces the unsatisfactory rate of Pap test slides, and detects a significantly higher number of low- and high-grade squamous lesions when compared with the conventional Pap smear technique. Biopsy confirmation shows that this increased detection does not come at a cost of decreasing specificity, and sensitivity for histologic dysplasia is equal to or greater than the best available data for the conventional Pap method. The SurePath collection vial provides residual cellular material for adjunctive out-of-the-vial molecular testing, including sexually transmitted diseases and oncologic biomarkers associated with cervical carcinoma. Finally, SurePath slides can be placed on an automated cervical cytology screening device (FocalPoint™), thus providing improved disease detection and enhanced laboratory productivity.

Validation of a Multiplex PCR Assay for the Simultaneous Detection of Human Papillomavirus and Chlamydia trachomatis in Cervical PreservCyt Samples

Chlamydia trachomatis is the most common sexually transmitted bacterium worldwide (1) and a leading cause of infertility in women (2). Human papillomaviruses (HPVs) are the most important single agent causing carcinoma of the uterine cervix (3). Combined molecular screening for C. trachomatis and HPV could be justified given their propensity to cause asymptomatic infections, particularly in high-risk groups. Features of HPV infection of cells of the uterine cervix are traditionally reported by the Pap smear method (4). The introduction of liquid-based cytology, such as the ThinPrep® Pap Test™, has had the effect of improving the sensitivity of conventional cytologic screening with the potential for HPV testing of residual cellular material in borderline or difficult cases (5)(6)(7). The US Food and Drug Administration (FDA) has recently cleared a hybrid capture-based system (HCII; Digene) for screening women over 30 years of age as an adjunct to Pap testing (8). Researchers have developed consensus primers for the detection of HPV DNA by PCR (9)(10). We developed and evaluated a multiplex PCR for the simultaneous detection of HPV and …

Comparison of Gram Stain and Pap Smear Procedures in theDiagnosis of Bacterial Vaginosis

The purpose of this study was to examine the characteristics of Gram stain versus Pap smear in diagnosis of bacterial vaginosis (BV). One-thousand and sixty women were enrolled in this study. All cases with symptoms of BV were determined by Amsel's criteria, which were accepted as the gold standard for diagnosis of BV. Pap smear and Gram stain evaluations were compared according to Amsel's criteria, without viewing the clinical results of the patients. Gram stain and Pap smear results were determined as negative or positive according to Amsel's criteria. Sensitivity, specifity and positive predictive values were calculated. After accepting the cases that were diagnosed as BV according to Amsel's criteria as reference cases, the sensitivity of the Gram stain method was calculated as 97% and the sensitivity of the Pap smear method as 93%. Similar specificity rates were obtained with both methods in diagnosis of BV related to the clinical results. There were no statistically significant differences in diagnosis of BV between these two groups. If Amsel's criteria are accepted as the gold standard for diagnosis of BV, Gram stain and Pap smear methods will give similar results in diagnosis.

Validation of the ThinPrep Papanicolaou Test for Cervical Cancer Diagnosis.

Although the accuracy of the Thin-Prep Papanicolaou (Pap) Test has been demonstrated in the detection of precursor lesions to cervical cancer, its performance in identifying invasive cancer has not been adequately evaluated. These studies were designed to determine the effectiveness of the ThinPrep method in diagnosing invasive cervical cancer. In four clinical studies, 47 cases of cervical cancer were processed by both conventional and ThinPrep techniques, and the cytological diagnoses and detection rates were compared. Additional studies evaluated the potential of cell loss during the ThinPrep filtration process. A diagnosis of cancer was made in 45 cases (95.7%) by the ThinPrep method and in 44 cases by conventional Pap smear (93.6%). In the two cases not diagnosed by the ThinPrep method, one was diagnosed as atypical squamous cells of undetermined significance and one as atypical glandular cells of undetermined significance. In the conventional smears, one of the three cases not identified as cancer was atypical squamous cells of undetermined significance, and the other two cases were unsatisfactory. In addition, the ability of the ThinPrep method to demonstrate tumor diathesis and to retain diagnostic cells by the filtration process was confirmed. These studies indicate that the ThinPrep method is at least equivalent to the conventional Pap smear method for the demonstration of squarnous cell carcinoma, adenocarcinoma, and other cervical malignancies.

Use of Pap Smear in General Practice by Case Finding or Screening Programme

Two different organizational methods of Pap smear examination in prevention of cancer colli uteri are compared in two Danish counties. In one county the method was planned as a pure case finding model; in the other county a modified screening approach was used. Resources were measured as the number of Pap smear examinations per 1 000 women of risk age (25-54 years). They were nearly identical in the two counties. The number of sufficiently investigated women, defined as examined by a Pap smear at least once within a 3-year period, was much larger in the county using the screening model than in the other county. Furthermore the proportion of women sufficiently investigated varied greatly in the county using the case finding model. Even the most active one-fourth of the doctors in this county did not obtain the same percentage of examined women as the average in percentage of examined women in the county with a regular screening programme, even though this active group of doctors had a resource consumption about twice the average for this county. It is concluded that the Pap smear method when aiming at a maximum interval between smears in individual women of 3 years, can be conveniently carried out in general practice by using a case finding model in combination with a screening programme together with a systematized, centrally computer-surveyed procedure, in order to avoid overlapping and exclude women not examined as well as possible.