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CAMHS won't see you now

Why don't we do more to beat hypertension?

I note with interest your correspondent's question regarding the changes in national cervical screening policy, and the answer (Answerback, June 28).

I am one of the small minority of GPs who have, with PCO approval, always organised my own cervical cytology call programme, which in terms of percentage uptake has been very successful.

This requires that I keep a closer watch on this aspect of practice than some of our colleagues usually need to do.

It is well recognised, and not arguable, that most minor cervical abnormalities will resolve spontaneously. The data on more severe abnormalities is much less clear, resting solely, I believe, on an uncontrolled trial performed some years ago in New Zealand.

I have on my practice list 54 patients who have had a severely dyskaryotic smear at some time in their life. Of these, 11 had this abnormality below the age of 25. Four were only 22. One was 20. All were referred to secondary care, and all were diagnosed at colposcopy as CIN III.

It is suggested these girls could have waited until age 25 for diagnosis and treatment; there is no meaningful evidence to support this contention. It has always been the perceived wisdom that most cases of CIN III will progress to frank malignant disease if not prevented. Three or four or, in one of my patients, five years, clearly could be long enough for this to occur.

True, cervical carcinoma is uncommon below the age of 25. I have seen two such patients; both died. I am certain that without early smearing I would have seen more, and I intend to continue to invite all girls to my well-woman clinic from the age of 20.

Dr A Bradbury


East Sussex

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