Cervical cancer screening: Liquid based cytology is successful

EDITOR—The results of Coste et al should be interpreted with some caution.1 They raise questions about the validity of such a small group of 2585 and of split sampling. An analysis is required on the amount of training of smear takers, laboratory staff, and cytopathologists. The contrast in appearance between conventional smears and thin layer slides will make it difficult to eliminate bias.

In Lothian 15 practices, which include areas of highest urban deprivation, are now in their fourth year of using ThinPrep samples as part of the routine cervical smear programme. The table shows the results.

Eighty per cent of Lothian's practices have had to continue to use conventional slide cytology, and their results continue to match the “before” data for the 15 practices. Pathology at colposcopy, which like cytology can only be a subjective report, also supports these results.

The reduction in unsatisfactory smears has had an immediate benefit for patients through reduced anxiety and fewer recalls, with a sizeable reduction in primary care and laboratory workload. The sensitivity of detection of high grade lesions ensures a more efficient progression to appropriate treatment.

The Scottish Executive's health department is to be commended on its decision to improve services to Scottish patients by rolling out liquid based cytology across Scotland by 2004. This decision was reached with political consensus and without personal or commercial bias. The recently published guidelines from the National Institute for Clinical Excellence (NICE) should provide further objective analysis for the future of the cytology screening programme.