The wheels of the Irish health system move rather slowly. However, even by normal standards, the situation in relation to cervical screening has been tortuous. A co-ordinated national screening programme was introduced in the UK 11 years ago, but not even a pilot programme is in place in the Republic.

Screening programmes work by reducing the incidence and the death rate from cervical cancer. Such a programme is acknowledged as a worthwhile preventive health measures when delivered in an organised manner using a computerised call and recall system.

At present Irish women attending for cervical smears do so on their own initiative. It is over two years since the Department of Health received the report of a cervical screening committee recommending the setting up of a programme.

However, not even the pilot programme planned for the Mid-Western Health Board has yet been put in place. Even if it is, possibly later this year, as stated by the Department yesterday, the projected time period of the project before it is expanded would be two years.

The National Women's Council is represented on that Department of Health committee. Its chairwoman, Ms Noreen Byrne, said the problem in the north-west clearly indicated the need to ensure the earliest possible implementation of the pilot project and the subsequent national programme. "We urgently call on the Minister for Health to immediately make available the resources, funding and personnel required to speed up the process of piloting this vital service for women all over the country," she said.

In the UK in recent times there have been a number of high-profile screening blunders. However, these perhaps illustrate the success of the programme, because quality assurance programmes are an integral part of it, and any statistical glitches are spotted.

About 80 Irish women a year die from cervical cancer. Dr Harry Comber, director of the National Cancer Registry, said very few deaths occurred in women under the age of 35, but from there the mortality incidence was spread evenly throughout age groups up to 74 years.

There is no doubting the value of having a smear test. According to statistics, if you have one you have reduced your risk of getting cervical cancer by 60 per cent, having one every five years by 86 per cent, every three years by 91 per cent, every year by 93 per cent.

An article in this week's British Medical Journal, reviewing the UK national call and recall system for testing, said there had been falls in cervical cancer in all regions and age groups from 30 to 74 years. The falls in mortality in older women, it said, were largely unrelated to screening, but without screening there may have been 800 more deaths in women under 55 years in 1997.

Not only are we still without a national programme in this State, hospitals and health boards are under-resourced to cope with tests from women coming forward voluntarily. In some cases, because of the backlog, women have to wait for months for a result, and as seen in the North-Western Health Board and North-Eastern Health Board areas, there are instances where they have to look outside for assistance.

Prof Walter Prendiville, a consultant obstetrician/gynaecologist, is a member of the Department of Health cervical screening committee. He said he hoped the national programme would be introduced as soon as possible. It was expected, he said, that the pilot scheme would be introduced next year.

"I would hope that the Department of Health would respond to the need for implementation of a national screening programme and not use the pilot programme as an excuse to delay, which I am sure they will not," Prof Prendiville said.

Explaining the reason for smear tests, he said there was a tiny piece of skin at the neck of the womb which was where 95 per cent of cervical cancers began, the remaining 5 per cent being further up the canal. If abnormalities are detected in the cells it can take more than 10 years for these to develop to cancerous cells, which could spread and cause harm.

"If you have a very mild abnormality most go back to normal on their own. If they look really severe there is a genuine chance of them going on to cancer. If a woman has not had a previous smear and the cells are abnormal we do not know where she is in that 10-year cycle."

He said that while there was a failure rate for smear-test results, there was overwhelming international evidence that a systematic call and recall system for women between the ages of 25 to 55 reduced their risk by up to two-thirds.

The time interval between when women would be recalled would depend on the result of their last smear. "However, in Ireland we leave that up to opportunity. Women who know about it get smeared. But if you do not call them in a systematic way you do not reduce the incidence at all."

If a smear result is abnormal, he said, in the vast majority of cases it can be treated. Traditionally, lasers were used, but now, said Prof Prendiville, the procedure involves a tiny loop of thin wire and a current, and takes seconds to complete.

Cervical cancer, he said, is associated with Human Papilloma Virus (HPV), which is probably the main cause of the disease. The majority of women with abnormal smears have got HPV, which is sexually transmitted. He pointed out that in some countries nearly half of the female population under the age of 30 have HPV. However, over the age of 30 this reduces to around 2 per cent.

"Finding oncongenic [cancer-causing] HPV in a young woman does not mean anything, but if it persists or is found in women over 30 it does mean something. It is a virus that an awful lot of people come across. However, for reasons we do not know, people deal with it differently. Smoking may have something to do with it."

At present it is the smear test rather than a test for HPV which is the "gold standard", he said, although HPV testing will probably be introduced in the next few years.

"There is growing evidence in Sweden that if you have a negative HPV and normal smear test you have at least 10 years before you would need another smear. It is true that if you are a virgin you will not get cervical cancer, rather than if you are a person with one or more sexual partners. The thing that will protect you is the smear."

Dr Sheila Jones, medical director of the Irish Family Planning Association, pointed out that it was those at greatest risk from cervical cancer who did not appear for screening. "Without a national screening programme we are probably missing out on a lot of women."