[Cervical smears: towards an optimal screening for cervical cancer]

THE INTEREST OF CERVICO-UTERINE CYTOLOGY: Cytology is the most appropriate means of screening for cancers and pre-cancerous states of the cervix. It permits the prevention of invasive cancers by identifying the precursor lesions, which exist more than 10 years before the invasion, and their effective excision or destruction. The absence of screening represents the greatest risk factor for invasive cancer and explains its higher frequency in developing countries. The Bethesda system is a language shared by cytologists and clinicians for spotting situations at risk Histology is essential before any therapeutic decision. It is provided by biopsies during colposcopy or by diagnostic coning in ambiguous situations. The cytological diagnosis of a low grade lesion and atypia of undetermined significance sometimes corresponds, histologically, to a high grade lesion. ENHANCING THE RESULTS OF SCREENING: The invasive cervical cancers still observed in France can be attributed to the lack of screening, lack of management and cytological false negatives. Conditions for optimising screening are wide coverage of women, good quality smears, competent cytologists and the appropriate follow-up of abnormal smears.