Editorial Comment
The (in)efficiency of cervical screening in Europe☆

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How to ensure organised programmes work most efficiently

It is clear that very few countries have made a sufficient investment to ensure the success of their organised programmes, the exceptions being England since 1988, Finland since 1963 and The Netherlands since 1996. There are probably many reasons for this, including a lack of political will, a lack of understanding by the decision-makers as to how an investment now will reap benefits in the future and opposition to the idea by some health professionals who feel threatened. It is sometimes

How to reduce opportunistic screening

Here, in addition to the special interests of those promoting such screening, there is the problem of a lack of understanding of the screening process, and the natural history of the disease. Education of primary care practitioners and gynaecologists is also required. It is disheartening to learn that in Sweden, a country that is advanced in so many ways, there is a financial barrier to participating in the organised programme that does not exist for opportunistic screening [15]. The remedy

The value in changing to 5-yearly re-screening

It is relevant that the countries that have the best organised programmes, and are being the most successful in achieving the desired impact, have all recommended 5-yearly screening (although in England some areas, for reasons unexplained by Patnick [10], apparently offer 3-yearly screening). The original International Agency for Research on Cancer (IARC) model suggested that there was a benefit in moving from 5- to 3-yearly screening [9], although even then it was difficult to reconcile this

Age to start screening

There is no question that the maximum age-related benefit is derived from starting screening at the age of 35 years [18]. However, in the context of the greater perceived value of a young life than an older one, and the greater recent sexual activity of the young, this will clearly be too old for any European country to accept. The question takes on a particular poignancy when one contemplates the question of Schaffer and colleagues [19] as to whether screening women up to the age of 35 years

Age to stop screening

Once again, it seems that many countries have failed to address this issue adequately. Those that have failed to introduce an upper age limit appear not to have recognised that beyond a certain age, women who have been adequately screened and always tested negative are at so low a risk of the disease that screening can be stopped. Many countries have decided that this age should be 60 years, a decision we initially took in Canada, although recognising that women who had never been screened over

Whether to move from cytology to one of its competitors

This question would seem to be beyond the topics raised by the Special Issue, except for the fact that it is specifically raised by Franceschi and colleagues [22]. Visual inspection with acetic acid (VIA) has such poor specificity compared with cytology that it can be dismissed from consideration in Europe until such time that this problem is solved, as the circumstances that make it necessary to evaluate it in developing countries do not exist in Europe. Human papilloma virus (HPV) testing is

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      In these countries, screening is mainly opportunistic, with the exception of a few isolated locally organised programmes. Opportunistic screening is characterised by too frequent testing, often performed by gynaecologists, and low coverage among older women, in socio-economically disadvantaged and high-risk categories, heterogeneous quality, uncontrolled introduction of new technologies and a poor level of monitoring.16,11,36–38 All these elements result in poor cost-effectiveness.

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    ☆

    Editorial Comment on the Special Issue “Cervical Cancer Screening in the European Union”.

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