BRITAIN'S #100m programme to screen women for cervical cancer was

founded on a ''mistake'' that must never be repeated, a team of

researchers claims in a report.

Its introduction 30 years ago was unevaluated. Now one in 10 young

women are falsely classified at risk after ''abnormal'' smear tests.

Thousands face the worry of possible cancer and some are treated for a

condition which they may never have, according to the team from Avon

Health Authority and Southmead hospital, Bristol.

It carried out a detailed study of detection rates in around 226,000

women in the Bristol screening programme. Despite a high uptake of

tests, it found that the expected eradication of 30 to 40 city deaths a

year had not materialised. The effect of screening on death rates was

too small to detect.

Now that screening was widespread, it concludes: ''We must simply face

the fact that we can never know for certain how much contribution

screening has made.''

The study by doctors Angela Raffle, Brian Alden, and Elizabeth

Mackenzie is reported in a leading article in the Lancet. Dr Mackenzie

was formerly director of the Bristol programme.

When screening was introduced nationally in 1966, cervical cancer was

associated with abnormal cells in smears. ''But the prevalence and

incidence of the abnormal cells on smears and the effectiveness, in

terms of mortality reduction, of finding and treating women with

abnormal cells has not been established,'' the study concludes.

As pressure for increased screening and revised methods grows for both

cervical and other cancers, it warns: ''It is essential that the

limitations of screening for cancer are sufficiently appreciated within

the medical profession and among the wider public to ensure that the

mistake of introducing an unevaluated screening programme will never

happen again.''

It finds ''encouraging'' the decline in national death rates -- down

to around 1660 from 2088 15 years ago. Much of that decline was

attributable to older women who had not been screened, it says.

It points out that, in each Bristol screening round, about 15,000

healthy women were being incorrectly told they were ''at risk'' and more

than 5500 were being further examined, with many also being treated.

Each round covers a five-year period.

''The real lesson from 30 years' cervical screening is that, no matter

how obvious the predicted benefit may seem for any screening test,

introduction should never take place without prior evaluation of both

positive and negative effects in controlled trials.''

In a statement concerning the Bristol study, the NHS Cervical

Screening Programme said cervical cancer was the most common cause of

death in women under 35.

It added: ''The women who are most at risk -- older women and those in

inner cities -- are now starting to reap the benefits of the improved

programme and the death rate among younger women is also starting to


''The evidence available clearly points to the benefits of the

screening programme and the national co-ordinating team is committed to

improving the existing quality systems and introducing even more

effective ones.''

Deaths in Scotland from cervical cancer have fallen from 244 in 1973

to 170 20 years later, a drop from 9 to 6 in the rate per 100,000


The rate among 35 to 44 year-olds has actually risen, from 5:100,000

to 9:100,000.

* A 32-year-old nurse who had to travel more than 150 miles for breast

reconstruction surgery yesterday urged women to speak out and ask for

the treatment.

Ms Claire Brown, from Glenurquhart, near Inverness, had to ask for a

referral to the specialist unit at the Western General Hospital in

Edinburgh for a joint operation to remove and rebuild her breast after

cancer was diagnosed.

The mother-of-two, who is due to be released from hospital today, is

backing the Scottish Breast Cancer Campaign, which has long argued for

equality of access for breast cancer sufferers to specialist units.

The results of rebuilding surgery are deemed to be much better if

carried out at the time of breast removal.

Raigmore NHS Trust, where Ms Brown was treated initially, has denied

any opposition to patients being referred to specialist breast units for

reconstruction surgery.