Cervical screening

摘要

Two expensive healthcare practices have recently been endorsed as policy in England and Wales. One is continuing to invite women over 50 for cervical screening; the other is shortening the screening interval from five years to three for younger women. National decisions on single issues disregard competing needs and force local decision makers to neglect other, more pressing, problems. To inform its decision the NHS cervical screening programme commissioned a case-control analysis. The difference between three yearly and five yearly screening is too small to measure, which is why we are having to use estimates, despite a huge natural experiment involv-ing widely differing screening intervals throughout the nation and worldwide. The analysis estimated that, for women under 40, the risk reduction is 30% with five yearly screening and 41% with three yearly screening. For women aged 40-54 years it is 63% and 69% respectively. The paper mentioned that three yearly screening costs 60% to 66% more than five yearly, and harm from over-diagnosis and over-treatment increases as screening interval decreases. This seems to have had no influence on the recommendations.