The standard test for cervical cancer, in use for the past 50 years, is likely to be replaced by a new, more accurate technique.
The National Institute for Clinical Excellence, the government watchdog on treatments, has recommended that the traditional Pap smear test be replaced by liquid-based cytology (LBC), which trials show is better at picking up potential cancers.
The proposals are subject to appeal but if confirmed will represent the biggest change to the national cervical screening programme since it was launched in 1989. In 2001-02, 3.8 million women aged 20 to 64 were screened and 4.4 million smears examined by laboratories.
The standard Pap test involves using a disposable spatula to take a scraping of cells from the cervix, which are then smeared on to a slide ready for examination in the laboratory. In almost one in ten cases (9.7 per cent in 2001), not enough cells are gathered or they become obscured by blood or other material. The smear has to be repeated, causing anxiety, inconvenience and discomfort. The figures suggest that in 2001 more than 400,000 smears had to be repeated.
The new LBC technique involves taking the sample of cells in the same way but using a brush-like device rather than a spatula. The head of the device is then rinsed or broken off into a vial of preservative fluid so that most or all of the cervical cells are retained for examination in the laboratory.
Pilot trials in four English hospitals demonstrated the improved accuracy of the new technique. An interim report published in December said there had been an 80 per cent reduction in the rate of inadequate smears, from 9.7 per cent to less than 2 per cent, a fall from 440,000 inadequate smears to 88,000.