Detection of Cervical Carcinoma in the General Population

Exfoliative cytology is no new science.Walshe, as long ago as 1851, observed fragments of malignant tissue in sputum, and Dudgeon and Patrick (1927), working at St. Thomas's Hospital with Dr. J. Bamforth, examined sputum, urine, and other body secretions for malignant cells.In 1928, in the United States, Papanicolaou used a similar wet fixation technique for diagnosing cancer of the female genital tract.It was not until the 1940's, however, that he realized the full use and significance of this as a routine diagnostic test, and then, in 1943, published his now classic paper with Traut.In Great Britain 3,500 women die from cervical cancer every year, or, one in a hundred of all female deaths is from cervical cancer.Unfortunately in the great majority of cases it cannot be detected in its early stage by reliance on clinical signs and symptoms, so that death rates continue to be high.The fact that the cervix is so easily accessible makes diagnosis by cytology parti- cularly applicable.There is therefore no technical difficulty, theoretically at least, in applying the method to an entire population.Cervical cytology has now passed beyond the experi- mental stage and its diagnostic value has been proved, in the United States, and inBritainbyAnderson (1950), Wachtel and Plester (1952), Way (1953), Egerton (1957), and Yule and Cameron (1961).The British Medical Journal (1962) expressed, what many leading gynaeco- logists have felt for some time, that this "method is essentially a screening test not aimed specially at the occasional out-patient but at all patients at risk-that is, it is usually made on a cervix of normal appearance."The Central Health Services Council (1961) recom- mended that "consideration should be given to the provision of more widespread facilities with commen- surate training arrangements."