[Cervical-vaginal smears: an unpopular test!]

Abstract

No screening test for cancer in asymptomatic patients can match the performance level of the Pap smear, yet no other screening test has been so strongly criticized in the popular press. For a large part, this paradoxical situation, greatly influenced by public opinion in the United States, has arisen from a utopic desire for a "perfect" screening system. Actually, though the Pap smear will never be 100% effective, it has made it possible to greatly reduce the prevalence of invasive cervical cancer. The fact that total eradication has not been achieved is not a sign of poor performance, but rather a signal for further improvement. Public education should be reinforced so the entire population, especially high risk groups of older women and those living in socially underprivileged conditions, can benefit from Pap smear screening programs. Clinicians and cytologists must also continue their efforts to assure quality smears and cytopathological examinations. In France, the Association for quality assurance in anatomy and pathological cytology, the Centers for collecting information on anatomy and pathological cytology, and the High Counsel for Public Health have taken innovative steps in this direction. The cytology report must also be written in a clear language, including a statement regarding the adequacy of the specimen, the description of the cells observed, a diagnosis and the use of an internationally accepted classification. Finally, patient follow-up is mandatory since the Pap smear technique is a screening method and cannot provide a definitive diagnosis. All positive smears must be confirmed by colposcopy and histologic assessment. Correctly used, the Pap smear remains the method of choice for the eradication of cervical cancer.