UK Cervical Cancer Screening Programme: Setting a Research Agenda

Abstract

The UK national cervical cancer screening programme aims at reducing the incidence of and mortality from carcinoma of the cervix. It is generally agreed that high grade cervical intraepithelial neoplasia should be treated aggressively, but the appropriate management strategies for women with lesser degrees of abnormality are uncertain because of the inability to distinguish lesions that are likely to progress to invasive disease from those that will regress spontaneously. The role of human papillomavirus (HPV) and the possible usefulness of HPV testing as a secondary screening tool in women with borderline or mild dyskaryosis is also unknown. This paper proposes an agenda for research into the uncertainties within the UK screening programme, suggesting that priority should be given to determining the most appropriate referral and management policies and the use of HPV DNA assay for women with borderline and mild dyskaryosis, so that those women at highest risk of developing invasive disease are treated. A randomised controlled trial is needed. The practical and methodological difficulties which would need to be considered and the need to convene a multidisciplinary research team to develop and implement the trial are highlighted. © 1994, Medical Screening Society. All rights reserved.