Women must be given fully informed information about cervical screening

Editor—The General Medical Council has now produced clear ethical guidelines with respect to getting informed consent from patients undergoing any medical procedure, including screening tests.¹,² This would include cervical screening.

The guidelines are quite specific in stating that a doctor or other party should explain the purpose of screening; the likelihood of positive and negative findings, including false negative and false positive results; uncertainties and risks of screening; important medical, social, or financial consequences of screening; and follow up plans, including counselling and support services. Several other, more general, points may also apply to screening, such as conflicts of interest due to financial benefits, the withholding of information necessary for decision making, and allowing patients sufficient time to reflect before and after they make a decision.

Leaflets given to patients and general practitioners about the cervical screening programme have been criticised for being misleading and not fully disclosing all the information required for women to make an informed decision about having this screening test.³ In particular there is the problem of false negative and false positive smears, which occur in all laboratories but are rarely made known to smear takers or women; the psychological problems after an abnormal smear; and the morbidity that may follow colposcopy and treatment for cervical intraepithelial neoplasia.

It is sometimes argued that the benefits to society of reducing the incidence of cervical cancer outweigh the rights of individual women to have this information in case it upsets them and they decide to refuse screening.⁴ Again the General Medical Council’s guidance is clear on this point, and such information should not be withheld on this basis. Some doctors—including me—believe that the NHS cervical screening programme should be more open and honest about the limitations and uncertainties of screening for cervical intraepithelial neoplasia and cervical cancer.³,⁴ It is therefore gratifying that this is, by implication, the view of the General Medical Council.

Perhaps now we can expect the NHS cervical screening programme to produce fully informative and honest literature for women and to ensure that this information is made available to the smear takers, who are clearly under an ethical obligation to provide it. The case for fully informed written consent before women have a smear test now seems stronger than ever.