[On the occasion of the 65th birthday of the cervical smear: added value of population studies for cervical cancer remains unclear]

Abstract

It was in 1941 that George Papanicolaou first published his article on the use of the vaginal smear for the detection of cancer. It was generally believed that this simple test would be a blessing for women and could ultimately eradicate death from cervical cancer. Several decades later it has become clear that complexity dominates the picture of this test and not simplicity. The visual interpretation of slides, the organisation of population screening, the interpretation of its effects, quality control, viral carcinogenesis and more recently what effect the introduction of vaccination (alone and in combination) will have are the issues involved. These issues are complex to such an extent that it is almost impossible to obtain empirical evidence on the efficacy of the population-screening programme.