Compliance in screening programmes High compliance essential in cervical screening programme..

EDITOR, - D J Torgerson and Cam Donaldson argue that the costs of achieving a high degree of compliance represent a lost opportunity for screening an alternative target population, as might be obtained by reducing the screening interval or screening older patients.1 They conclude that committing resources to increasing compliance may not be the most cost effective method of arriving at an overall reduction in mortality and that screening programmes can be efficient with low levels of compliance. This does not seem to be the case with screening for cervical cancer.

Even in an established programme of screening for cervical cancer a high proportion of cases of invasive cancer arises in unscreened women.2 Several studies have shown that alternative management schedules for women with abnormalities on smear testing alter only slightly the occurrence of invasive cancer among the women being followed up.^3,4 Using a stochastic model of the natural course of precancer and its detection by …