Is a Pap smear enough?

Cervical cancer is the eighth commonest cancer seen in women in Australia. It is largely preceded by precancerous changes, which can be detected by exfollative cytology and then treated. Of all Pap smears taken in Australia, 80-90% are performed within general practice. New technologies (rescreening by a computer monitored microscope, and fluid based cytology, as well as human papillomavirus DNA testing) are now available as additional tests to the conventional Pap smear.

To discuss the question of whether GPs should offer these additional tests to women having Pap smears.

Adding the two new cytology tests on a routine basis to women being screened would increase the detection rate of high grade abnormalities from about 1% of all smears diagnosed to 1.05% at a cost of $30 million per annum in Victoria alone. While there may be some situations where offering these tests is warranted, the main aim of doctors in preventing cervical cancer should still be that of recruitment and good Pap smear technique.