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. 1992 Aug;42(361):336–339.

Abnormal cervical smear test results: old dilemmas and new directions.

C Wilkinson 1
PMCID: PMC1372177  PMID: 1457156

Abstract

Primary care professionals play a major role in the cervical screening programme in the United Kingdom, especially since the new contract for general practitioners. Many aspects of the programme are still the subject of broad debate and detailed research. New policies regarding the programme are generated at various levels; feedback is not always made directly available to primary care teams. This review article attempts to summarize the current available literature on cervical screening, focusing on the meaning of minor degrees of dysplasia, cervical cancer in younger women, the role of the wart virus, frequency of smear tests, diagnosis and treatment, counselling, and concludes with practical advice to help the practice team.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson G. H., Boyes D. A., Benedet J. L., Le Riche J. C., Matisic J. P., Suen K. C., Worth A. J., Millner A., Bennett O. M. Organisation and results of the cervical cytology screening programme in British Columbia, 1955-85. Br Med J (Clin Res Ed) 1988 Apr 2;296(6627):975–978. doi: 10.1136/bmj.296.6627.975. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Beardow R., Oerton J., Victor C. Evaluation of the cervical cytology screening programme in an inner city health district. BMJ. 1989 Jul 8;299(6691):98–100. doi: 10.1136/bmj.299.6691.98. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Campion M. J., McCance D. J., Cuzick J., Singer A. Progressive potential of mild cervical atypia: prospective cytological, colposcopic, and virological study. Lancet. 1986 Aug 2;2(8501):237–240. doi: 10.1016/s0140-6736(86)92067-2. [DOI] [PubMed] [Google Scholar]
  4. Chomet J., Chomet J. Cervical screening in general practice: a "new" scenario. BMJ. 1990 Jun 9;300(6738):1504–1506. doi: 10.1136/bmj.300.6738.1504. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Choyce A., McAvoy B. R. Cervical cancer screening and registration--are they working? J Epidemiol Community Health. 1990 Mar;44(1):52–54. doi: 10.1136/jech.44.1.52. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Cook G. A., Draper G. J. Trends in cervical cancer and carcinoma in situ in Great Britain. Br J Cancer. 1984 Sep;50(3):367–375. doi: 10.1038/bjc.1984.185. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Cuckle H. S. Screening with discrimination. BMJ. 1990 Oct 20;301(6757):889–890. doi: 10.1136/bmj.301.6757.889. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Eardley A., Elkind A. K., Spencer B., Hobbs P., Pendleton L. L., Haran D. Attendance for cervical screening--whose problem? Soc Sci Med. 1985;20(9):955–962. doi: 10.1016/0277-9536(85)90352-1. [DOI] [PubMed] [Google Scholar]
  9. Elkind A., Eardley A., Thompson R., Smith A. How district health authorities organise cervical screening. BMJ. 1990 Oct 20;301(6757):915–918. doi: 10.1136/bmj.301.6757.915. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Ellman R. Problems of follow-up for abnormal cervical smears: discussion paper. J R Soc Med. 1990 Feb;83(2):94–95. doi: 10.1177/014107689008300213. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Giles J. A., Gafar A. The treatment of CIN: do we need lasers? Br J Obstet Gynaecol. 1991 Jan;98(1):3–6. doi: 10.1111/j.1471-0528.1991.tb10301.x. [DOI] [PubMed] [Google Scholar]
  12. Haddad N. G., Hussein I. Y., Livingstone J. R., Smart G. E. Colposcopy in teenagers. BMJ. 1988 Jul 2;297(6640):29–30. doi: 10.1136/bmj.297.6640.29. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Hammond R. H., Edmonds D. K. Does treatment for cervical intraepithelial neoplasia affect fertility and pregnancy? BMJ. 1990 Dec 15;301(6765):1344–1345. doi: 10.1136/bmj.301.6765.1344. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Havelock C. M., Webb J., Queenborough J. Preliminary results of a district call scheme for cervical screening organised in general practice. BMJ. 1988 Nov 26;297(6660):1384–1386. doi: 10.1136/bmj.297.6660.1384. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Ismail S. M., Colclough A. B., Dinnen J. S., Eakins D., Evans D. M., Gradwell E., O'Sullivan J. P., Summerell J. M., Newcombe R. G. Observer variation in histopathological diagnosis and grading of cervical intraepithelial neoplasia. BMJ. 1989 Mar 18;298(6675):707–710. doi: 10.1136/bmj.298.6675.707. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Kessler I. I. Perspectives on the epidemiology of cervical cancer with special reference to the herpesvirus hypothesis. Cancer Res. 1974 May;34(5):1091–1110. [PubMed] [Google Scholar]
  17. Macgregor J. E., Moss S. M., Parkin D. M., Day N. E. A case-control study of cervical cancer screening in north east Scotland. Br Med J (Clin Res Ed) 1985 May 25;290(6481):1543–1546. doi: 10.1136/bmj.290.6481.1543. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. McCormick J. S. Cervical smears: a questionable practice? Lancet. 1989 Jul 22;2(8656):207–209. doi: 10.1016/s0140-6736(89)90384-x. [DOI] [PubMed] [Google Scholar]
  19. Meanwell C. A. The epidemiology of human papillomavirus infection in relation to cervical cancer. Cancer Surv. 1988;7(3):481–497. [PubMed] [Google Scholar]
  20. Mitchell H., Drake M., Medley G. Prospective evaluation of risk of cervical cancer after cytological evidence of human papilloma virus infection. Lancet. 1986 Mar 15;1(8481):573–575. doi: 10.1016/s0140-6736(86)92807-2. [DOI] [PubMed] [Google Scholar]
  21. Mitchell H., Medley G., Giles G. Cervical cancers diagnosed after negative results on cervical cytology: perspective in the 1980s. BMJ. 1990 Jun 23;300(6740):1622–1626. doi: 10.1136/bmj.300.6740.1622. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Morell N. D., Taylor J. R., Snyder R. N., Ziel H. K., Saltz A., Willie S. False-negative cytology rates in patients in whom invasive cervical cancer subsequently developed. Obstet Gynecol. 1982 Jul;60(1):41–45. [PubMed] [Google Scholar]
  23. Muir Gray J. A., Chamberlain J. Cervical screening management. Lancet. 1989 Jul 29;2(8657):280–280. doi: 10.1016/s0140-6736(89)90468-6. [DOI] [PubMed] [Google Scholar]
  24. Murphy M. F., Campbell M. J., Goldblatt P. O. Twenty years' screening for cancer of the uterine cervix in Great Britain, 1964-84: further evidence for its ineffectiveness. J Epidemiol Community Health. 1988 Mar;42(1):49–53. doi: 10.1136/jech.42.1.49. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Nuovo G. J., Blanco J. S., Leipzig S., Smith D. Human papillomavirus detection in cervical lesions nondiagnostic for cervical intraepithelial neoplasia: correlation with Papanicolaou smear, colposcopy, and occurrence of cervical intraepithelial neoplasia. Obstet Gynecol. 1990 Jun;75(6):1006–1011. [PubMed] [Google Scholar]
  26. Paterson M. E., Peel K. R., Joslin C. A. Cervical smear histories of 500 women with invasive cervical cancer in Yorkshire. Br Med J (Clin Res Ed) 1984 Oct 6;289(6449):896–898. doi: 10.1136/bmj.289.6449.896. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Pinion S. B., Kennedy J. H., Miller R. W., MacLean A. B. Oncogene expression in cervical intraepithelial neoplasia and invasive cancer of cervix. Lancet. 1991 Apr 6;337(8745):819–820. doi: 10.1016/0140-6736(91)92518-7. [DOI] [PubMed] [Google Scholar]
  28. Raffle A. E., Alden B., Mackenzie E. F. Six years' audit of laboratory workload and rates of referral for colposcopy in a cervical screening programme in three districts. BMJ. 1990 Oct 20;301(6757):907–911. doi: 10.1136/bmj.301.6757.907. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Richart R. M. A modified terminology for cervical intraepithelial neoplasia. Obstet Gynecol. 1990 Jan;75(1):131–133. [PubMed] [Google Scholar]
  30. Riou G., Favre M., Jeannel D., Bourhis J., Le Doussal V., Orth G. Association between poor prognosis in early-stage invasive cervical carcinomas and non-detection of HPV DNA. Lancet. 1990 May 19;335(8699):1171–1174. doi: 10.1016/0140-6736(90)92693-c. [DOI] [PubMed] [Google Scholar]
  31. Robertson J. H., Woodend B. E., Crozier E. H., Hutchinson J. Risk of cervical cancer associated with mild dyskaryosis. BMJ. 1988 Jul 2;297(6640):18–21. doi: 10.1136/bmj.297.6640.18. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Ross S. K. Cervical cytology screening and government policy. BMJ. 1989 Jul 8;299(6691):101–104. doi: 10.1136/bmj.299.6691.101. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Shafi M. I., Finn C. B., Blomfield P., Buxton E. J., Leusley D. M., Jordan J. A. Cervical cancer: need to look and recognise. Lancet. 1991 Aug 10;338(8763):388–389. doi: 10.1016/0140-6736(91)90527-v. [DOI] [PubMed] [Google Scholar]
  34. Shy K., Chu J., Mandelson M., Greer B., Figge D. Papanicolaou smear screening interval and risk of cervical cancer. Obstet Gynecol. 1989 Dec;74(6):838–843. [PubMed] [Google Scholar]
  35. Singer A., Jenkins D. Viruses and cervical cancer. BMJ. 1991 Feb 2;302(6771):251–252. doi: 10.1136/bmj.302.6771.251. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Skehan M., Soutter W. P., Lim K., Krausz T., Pryse-Davies J. Reliability of colposcopy and directed punch biopsy. Br J Obstet Gynaecol. 1990 Sep;97(9):811–816. doi: 10.1111/j.1471-0528.1990.tb02575.x. [DOI] [PubMed] [Google Scholar]
  37. Szarewski A., Cuzick J., Edwards R., Butler B., Singer A. The use of cervicography in a primary screening service. Br J Obstet Gynaecol. 1991 Mar;98(3):313–317. doi: 10.1111/j.1471-0528.1991.tb13400.x. [DOI] [PubMed] [Google Scholar]
  38. Tidy J. A., Parry G. C., Ward P., Coleman D. V., Peto J., Malcolm A. D., Farrell P. J. High rate of human papillomavirus type 16 infection in cytologically normal cervices. Lancet. 1989 Feb 25;1(8635):434–434. doi: 10.1016/s0140-6736(89)90023-8. [DOI] [PubMed] [Google Scholar]
  39. Tidy J. A., Vousden K. H., Farrell P. J. Relation between infection with a subtype of HPV16 and cervical neoplasia. Lancet. 1989 Jun 3;1(8649):1225–1227. doi: 10.1016/s0140-6736(89)92329-5. [DOI] [PubMed] [Google Scholar]
  40. Wilkinson C., Jones J. M., McBride J. Anxiety caused by abnormal result of cervical smear test: a controlled trial. BMJ. 1990 Feb 17;300(6722):440–440. doi: 10.1136/bmj.300.6722.440. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Wolfendale M. R., King S., Usherwood M. M. Abnormal cervical smears: are we in for an epidemic? Br Med J (Clin Res Ed) 1983 Aug 20;287(6391):526–528. doi: 10.1136/bmj.287.6391.526. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Young L. S., Bevan I. S., Johnson M. A., Blomfield P. I., Bromidge T., Maitland N. J., Woodman C. B. The polymerase chain reaction: a new epidemiological tool for investigating cervical human papillomavirus infection. BMJ. 1989 Jan 7;298(6665):14–18. doi: 10.1136/bmj.298.6665.14. [DOI] [PMC free article] [PubMed] [Google Scholar]

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