Cervical screening to change: Plan to raise standard of service

BRITAIN'S 'piecemeal' cervical screening programme is to be reorganised to raise standards and reassure women that it is worthwhile, Dr Kenneth Calman, the Chief Medical Officer, said yesterday.

At the same time Dr Calman revealed plans for the first co-ordinated plan for existing and future screening programmes and said that no new national screening would be introduced unless its benefits had been properly assessed by formal research first.

His statements on cervical screening follow several incidents including below-standard laboratory work at Inverclyde Royal hospital, Strathclyde, which led to the reassessment of 20,000 smear tests. In another recent incident a nurse was using the wrong spatula to conduct the test and in another a doctor was using his finger.

'Recent isolated incidents have suggested that some women may not have received the standard of service which they have a right to expect. We are taking forward a number of initiatives within the NHS so that such incidents do not happen again,' he told a conference in London on screening, organised by the British Medical Journal to launch a new magazine, the Journal of Medical Screening.

The steps are designed to improve the quality and management of cervical screening and to iron out variations in local practice. Dr Calman said that the smear tests, to detect cancer of the cervix or pre-cancerous cells which can lead to it, began in the 1960, but in a piecemeal way, without the backing of scientifically based trials that proved its benefits.

However, between 70 and 80 per cent of women aged 20 to 64 are now screened and deaths from cancer of the cervix have fallen from 1,942 in 1988 to 1,647 in 1992.

Dr Calman said they would spend pounds 100,000 on an improved system of guidelines and training for GPs and appoint a national co-ordinator. In addition, new systems for ensuring national standards are met in the 220 UK laboratories are to be introduced.

'We are providing further training materials to Family Health Service Authorities and asking them to implement urgently professional training for practice nurses to ensure professional competence,' he said.

Studies to assess the effectiveness of cervical screening are also being introduced.

Four million tests are carried out a year. Dr Muir Grey, who has been the secretary of the Government's co-ordinating committee on cervical screening, the forerunner of the new structure, said that one of its concerns was the high number - about a quarter - of 'false-positive' cases, which result in women being given the test annually just in case cancer or pre-cancerous cells have developed. False-positive results wrongly suggest there are abnormal cells.

'This over-referral causes a great deal of anxiety. In some programmes between one-third and one-quarter of the women are on these rapid recall systems,' he said.

The British Medical Association said last night that no more than 'a handful' of GPs failed to carry out cervical smears adequately.