Population-based cervical screening has been promoted widely and enthusiastically as a preventive measure for cervical cancer since the development of the Papanicolaou smear test in the 1940s. In 1984 the Imperial Cancer Research Fund Co-ordinating Committee on Cervical Screening1 confidently announced “With the exception of stopping the population from smoking, cervical cytological screening offers the only major proved public health measure for significantly reducing the burden of cancer today.”

Throughout its history, however, the ‘Pap’ smear has been subject to intense criticism. Critics have wondered whether many lesions or dysplasias identified by smears and treated would have developed into cancer if left alone. From the 1960s, in the light of the growing importance attached to the sciences of biostatistics and epidemiology, others questioned whether screening programmes had reduced the incidence of cervical cancer. Feminists from the 1980s critiqued the interventionist medical model, arguing that the costs to individual women outweighed the public health benefits. Archie Cochrane, Professor of Epidemiology and the doyen of evidence-based medicine, claimed that the subject of cervical screening in Great Britain was highly emotional, and “never has there been less appeal to evidence and more to opinion”.2 3 This article revisits the debates, focusing in particular on the critiques that have existed as long as the screening programmes themselves.

AN EPITAPH FOR CERVICAL CANCER

At the 1960 American Medical Association annual meeting, chairman Dr Curtis Lund4 announced that an epitaph for cervical carcinoma could be written “The lethal methods are ready, only the proper application remains.” The method referred to was the Papanicolaou smear test, developed in America.

The American Society for the Control of Cancer (later the American Cancer Society; ACS) was founded in 1913 specifically to combat the fatalistic attitude to cancer by arguing that it was curable if caught early.5 The problem for cancer …