Papanicolaou smears in Victoria: are the wrong women being screened?

While a mismatch is evident in the age distribution of women who are smear-tested by the Victorian Cytology (Gynaecological) Service (VC(G)S) and the women who are developing and dying of invasive cancer of the cervix, evidence is presented that the screened population have significant morbidity from precursor lesions. Women whose cervical cytological examination is undertaken by the VC(G)S have higher detection rates for carcinoma-in-situ than does the general population; a more than three-fold excess over the SA Cancer Registry rates is evident. During 1984 one in 148 of the women who were screened by the VC(G)S had histologically-proved dysplasia or carcinoma-in-situ in contrast with one in 5606 Australian women who were diagnosed as having invasive cancer of the cervix. These results indicate that the women who are currently screened should not be considered an intrinsically low-risk group for cervical malignancy.