Detection of Carcinoma of the Uterine Cervix

Nearly 30 years have elapsed since Papanicolaou and Traut published their classical works, "The diagnosis of uterine cancer by the vaginal smear."1Within the last 20 years there has been an ever increasing use of this simple and painless technique for the early diagnosis of carcinoma of the cervix. Yet, as Nyirjesy in this issue ofJAMApainfully brings into focus, this is hardly the moment to be complacent about the effectiveness of cytologic screening. Nyirjesy's paper points out that continuing use of Papanicolaou's classes as a means of communicating the results of cervical screening to the clinician carries with it major dangers: what is a class II smear to some, may prove to be class III or perhaps even class IV or V smear to others. Obviously in Nyirjesy's setting some very important lesions of the cervix (including invasive cancer) were diagnosed as class II or atypical smear.