Position Statements

Screening for cancer of the cervix

Cervical cancer is the commonest cancer to afflict women in South Africa with the reported incidence that is one of the highest in the world. The disease affects women in the prime of their lives resulting in disastrous effects on the woman's family and has a massive socio-economic effect on the country.

It has been well documented that cervical cytology (Papanicolaou smears) can confidently predict the presence of pre-malignant or malignant lesions of the cervix in the majority of cases. Treatment of the pre-malignant (CIN) lesions of the cervix will in almost all cases prevent the subsequent development of invasive cancer of the cervix. Therefore, in countries where national screening programmes have been implemented, the prevalence of invasive cervical cancer has decreased dramatically. In South Africa, the lack of a functional mass screening policy is the main factor responsible for the high incidence of cervical cancer. Since facilities for screening are available in South Africa, every woman in the country should have the right to be screened. Due to the high cost of western style screening programmes SASOG endorses the policy of the national Department of Health (yet to be implemented) that all women receive 3 smears in their lifetime, from age 30 years onwards with 10-year intervals. SASOG urges the implementation of this programme as soon as possible.

If women chooses to undergo more frequent smears, for example in the private sector, then a programme of annual smears for 3 years after onset of sexual activity is recommended. If those smears are normal, follow-up smears every 3 years would be sufficient.

In all cases with abnormal smear results, patients should be referred to facilities where colposcopy and local excision or destruction of the area of abnormality can be achieved. Such treatment facilities should be available throughout the country with the necessary expertise and equipment. For patients requiring treatment, annual follow-up is recommended.

Prepared by Dr Tony Koller, Dr Bash Goolab, Prof Lyn Denny and Prof Hennie Cronje.
Edited by Prof Gerhard Lindeque
August 2001