Cervical cancer screening. Human benefits and human costs in the evaluation of screening programmes

INTRODUCTION THE SCIENTIFIC evidence of the effectiveness of screening for cervical cancer in reducing the incidence and mortality is well established and acknowledged by the scientific community [ 1, 21. Screening programmes are applicable as public health policy [ 1, 21. However, although screening is widespread in European countries, the potential benefits of screening have not been achieved. This is partly because smears are not distributed in an optimal way, and partly because the standards of screening vary across countries. Homogenous standards are necessary in order to make comparable evaluations of the effectiveness and quality of different screening programmes. Quality assurance guidelines have to be adopted for increasing the potential benefits and, no less important, for reducing the potential adverse effects of cervical cancer screening. The scientific evidence concerning human benefits and human costs of cervical screening form the background for the evaluation of effectiveness and for the definition of quality assurance standards. From the ethical point of view, the duty of carefully evaluating the adverse effects of screening is strengthened by the fact that screening addresses healthy people.