Intended for healthcare professionals

Rapid response to:


Hereditary haemochromatosis: to screen or not

BMJ 1999; 319 doi: (Published 28 August 1999) Cite this as: BMJ 1999;319:531

Rapid Response:

Cervical screening: cost effective or not?

In their editorial on screening for hereditary haemochromatosis,
Haddow and Bradley consider that a ratio of 1 patient benefiting for every
10 treated is unacceptable (1). I wonder, therefore, what they would make
of the considerably higher ratios found in screening for pre-malignant
disease of the uterine cervix?

The NHS Cervical Screening Programme in England labels over 250,000
women per annum as having an abnormal cervical smear. Of these women, about 120,000 each year
are treated in order to prevent an estimated 800 deaths annually from the disease,
a ratio of 150 to 1(2,3). Many of these women believe that they have had a
life threatening cancer; they have not. In fact up to 14% have no evidence
of cervical intraepithelial neoplasia at all (2). Given that nearly half
of consultant pathologists and biomedical scientists employed in the
cervical screening programme admit to overcalling cervical smears for fear
of missing serious disease, then this percentage is likely to increase
(4). The cost benefit ratio of cervical screening in the UK will therefore
deteriorate further as more and more women are subjected to unnecessary

At risk of being considered politically incorrect, perhaps it is time
to think the unthinkable and to seriously reconsider whether the present
cervical screening programme continues to represent a cost effective
health intervention? At a cost of over £100,000 per life saved, almost
half of consultant pathologists in the UK believe it is not (4).

Yours sincerely

Dr. John Nottingham, FRCPath.

Consultant Histopathologist.



1. Haddow JE, Bradley LA. Hereditary haemochromatosis: to screen or
BMJ 1999; 319:531-2.

2. Statistical bulletin. Cervical Screening Programme, England: 1997-
98. Department of Health. London. January 1999.

3. Quinn M, Babb P, Jones J, Allen E, on behalf of the United Kingdom
Association of Cancer Registries. Effect of screening on the incidence of
and mortality from cancer of the cervix in England: evaluation based on
routinely collected statistics. BMJ 1999; 318: 904-8.

4. Brown DC, Griffiths D. A survey of biomedical scientists and
consultant pathologists involved in the cervical screening programme.
Cytopathology 1999; 10: 229-239.

Competing interests: No competing interests

07 September 1999
John Nottingham
Consultant histopathologist
George Eliot Hospital NHS Trust, Nuneaton , Warwickshire, CV10 7DJ.