V. Conclusions and recommendations second smear should be taken within reported to the patient's physician or 1 year. other person responsible for the pa¬ The members of the task force contient's health care. (c) Provided the initial two smears clude that: and all subsequent smears are sat¬ (h) Follow-up mechanisms exist to ensure that action appropriate to the I. Squamous carcinoma of the cervix isfactory and without significant lends itself to control by means of a atypia, further smears should be findings has been implemented. taken at approximately, 3-year inter¬ cytologic screening program because: IV. A screening program will use vals until the age of 35, and thereafter (a) Invasive squamous carcinoma resources most efficiently when it con¬ at 5-year intervals until the age of 60. of the cervix is preceded by a spec¬ centrates on bringing women into the trum of disease, extending over many program and when the frequency of (d) Women over the age of 60 who have had repeated satisfactory years, which may be recognized at examination is tailored to the degree of smears without significant atypia may the stages of dysplasia and carcinoma risk rather than when examinations are be in situ. dropped from a screening pro¬ on the annual performed "customary" gram for squamous carcinoma of the (b) In a significant proportion of basis: cervix. patients with evidence of dysplasia (a) A woman is considered at risk or carcinoma in situ the disease, if (e) Women who are not at high for the development of squamous risk should be discouraged from untreated, will develop into invasive carcinoma of the cervix as soon as having smears more frequently than squamous carcinoma. she becomes sexually active. is recommended above. (c) Cytologic evidence of the exist¬ (b) Within the group of women at ence of dysplasia and carcinoma in (f) Women at continuing high risk risk, a high-risk subgroup is recog¬ should be screened annually. To fasitu can be easily, safely and econom¬ nized; essentially it consists of those cilitate this, provision for taking ically obtained by the preparation women who have had an early onset and examination of smears. cytologic smears should be made of sexual activity, especially with at family-planning clinics, student (d) Once dysplasia or carcinoma multiple partners. health clinics, youth clinics, venereal in situ has been identified, further A woman may be assumed to (c) disease clinics, prenatal clinics, and progress of the disease can be pre¬ be no longer at risk for the develop¬ medical facilities where women are vented by simple therapeutic proce¬ ment of squamous carcinoma of the examined before admission to penal dures and continuing surveillance. cervix when, having participated institutions. II. There is evidence that, in regularly in the program, she reaches To function efficiently a labora¬ the of without a IV. 60 Canada: age having had smear should tory showing significant atypia. process at least 25 000 (a) Cytologic screening programs are becoming effective in reducing (d) Women who have never been gynecologic smears per annum and be sexually active are in a low-risk staffed with a minimum of three quali¬ mortality from carcinoma of the fied and experienced cytotechnologists cervix. group. (b) The extent of reduction in mor¬ V. There is no evidence that a cer¬ supervised by a cytopathologist, along tality achieved is directly related to vical cytologic screening program will with adequate clerical and technical the proportion of the population that reduce the mortality from other gyne¬ support staff. has been screened. V. Laboratories should employ ac¬ cologic or medical conditions. (c) The prevalence of abnormalities methods of quality control. ceptable in an unscreened population is of the Recommendations VI. All mass screening programs order of 5.5/1000. If such a popula¬ should have follow-up systems. Their

Conclusions

tion is re-examined the incidence of abnormalities is of the order of 0.5 to 0.7/1000. III. A cytologic screening program will be most effective if: (a) Smears are obtained by med¬ ical or specially trained paramedical

personnel. (b) Smears are correctly identified and accompanied by the information required by the program. (c) Smears are screened for ab¬ normalities by qualified and experi¬ enced cytotechnologists under the supervision of cytopathologists. (d) Smears are processed in labo¬ ratories handling at least 25 000 gynecologic specimens annually. (e) Suitable quality-control is exer¬ cised in the laboratory. (f) Precise terminology such as that recommended elsewhere in this report is employed. (g) Results of the examinations are

On the basis of the conclusions stated are to ensure: above, the members of the task force functions (a) That normal patients recommend that:

are re-

called at

regular intervals for repeat I. Health authorities encourage and smears according to the guidelines of support the development of cytologic the program. screening programs designed to detect (b) That action is taken following the precursors of clinical invasive carci¬ the discovery of a cytologic abnor¬ noma of the cervix. mality. II. Appropriate means should be (c) That long-term follow-up be employed: for patients who have re¬ provided (a) To inform women of their de¬ ceived treatment following the diag¬ gree of risk of developing carcinoma nosis of an abnormality. of the cervix. Such a system can only be effected (b) To persuade all women at risk through a centralized registry. In Can¬ to participate in the screening pro¬ ada, provincial registries should estab¬ gram. lish uniform data-processing systems so III. An effective and sufficient fre¬ that interprovincial communication and quency of examination is as follows: will be possible. comparisons (a) Initial smears should be ob¬ VII. Provincial registries should be tained from all women over the age of 18 who have had sexual inter¬ established to record data and to carry out recommendations VI(a) and VI(c). course. VIII. A uniform terminology should (b) If the initial smear is satisfac¬ tory and without significant atypia, a be used for reporting purposes. ¦ CMA JOURNAL/JUNE 5, 1976/VOL. 114 1033