EDITOR—Pearson et al were concerned to find that only a quarter of eligible women with learning disability in Exeter and District Community Health Services NHS Trust had undergone cervical screening in the previous five years, compared with 82% of the rest of the eligible population.1 In 1997, Horizon NHS Trust, Hertfordshire Health Promotion, and the Women's Nationwide Cancer Control Campaign cooperated over an intensive programme to screen the 126 eligible women in the learning disability hospital. As previous experience had shown the importance of securing carers' support, staff and some patients participated in educational sessions. The members of the trust's sex education team provided advice and educational models and made themselves available in case the process should provoke disturbing memories, as might happen in the case of previous sexual abuse.

Given the screening—as opposed to curative—nature of the procedure, no resident was tested who withheld consent (whether valid or not) or failed to cooperate passively. Despite the procedure being a routine public health measure, relatives were, as a matter of good practice, informed unless the patient indicated on direct questioning that they should not be.

Of the 128 eligible women, 40 were withdrawn because they were considered to be behaviourally or physically unable to participate. Of the …