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Quality Control in Cytological Screening for Cervical Cancer 1

My contribution to this symposium will be on the lines of the efficiency of the screening programme. The very essence of success of such a programme must be its ability to achieve its target. This means that the target has to be concisely and comprehensively defined and the means of achieving it presented with clear detail. By this I mean not only must the whole population at risk be identified but also concentration on the higher risk categories should occur, and both the upper and lower age limits and frequency of testing defined. I will leave the latter details to Mr. Boddington who has some very pertinent things to say on the frequency of recall and I will dwell on the efficiency of the system of screening and the monitoring thereof. The cytological screening for cervical cancer can be separated into three main categories: 1) the obtaining of the test material, 2) the test itself, and 3) the subsequent management and control of both the positive and the negative result cases. It is obvious that we cannot dwell overlong on the first item, that of obtaining a population response, but the very nature of the requirement needs a comprehensive and updatable master file so that an accurate measure of response can be achieved at any stage and the different population herd groups catered for. It is here that the use of caravans visiting the high-rise homes or factories or of nurses collecting at home, or the self-collecting pipettes all play a part in the pursuance of the more vulnerable, and by suitable quality control monitoring will demonstrate each its own particular value (table 1). It is on the second category that I will dwell in some detail as it affects us cytologists more. Why is it that with 25 to 30 years of experience we still get failure rates of such a simple biological test as shown in Table 2. We see some of the reasons in this chart where the error rate increases when invasive cancer is present due to the slough overlying the tumor. The failures in sampling have been due to three main reasons: that of 1) biological variability, 2) faulty collection of the test sample, and 3) the laboratory errors of the test, be they from processing, screening or interpretation.