Undoubtedly, women with smears showing severe dyskaryosis should have immediate colposcopy; many doctors believe that those with moderate dyskaryosis should be treated in the same way. But what to do about mild dyskaryosis is much less clear cut, and, indeed, the diagnosis is very subjective. According to the NHS cervical screening programme's guidelines, no justification exists for immediate colposcopy for mild dyskaryosis, but the programme wanted further research to determine whether cytological surveillance was as safe and effective as colposcopy.1 Such research is being conducted prospectively by the Aberdeen birthright project and is reported in this week's journal (p 1399).2

The arguments in favour of immediate colposcopy are that it allows early assessment and diagnosis - useful, given the well documented association between mild cytological abnormalities and high grade cervical intraepithelial neoplasia.^3,4 In this week's journal, Soutter and Fletcher report that …