ORIGINAL ARTICLES

Cancer of the cervix is the second most common cancer in women in South Africa, and the most common cancer in women aged 15- 29 years and 30- 54 years, accounting for 12.5 % and 25.7 % respectively.1 A National Screening Policy was instituted in South Africa in 2001.2 The State health system will pay for three cervical smear tests in a lifetime, commencing at the age of 30. Screening coverage has been shown to be more important than interval of screening in Scandinavian countries.3 Cytological screening for cervical cancer in Johannesburg primary health care facilities has achieved 20 % coverage4 and there is a commitment to increase this. Papanicolaou smear screening and treatment of premalignant cervical abnormalities was shown to reduce the incidence of cervical cancer in Europe and North America.5 There are few dedicated clinics for the treatment of premalignant disease of the cervix in South Africa. A one-stop clinic for diagnosis and treatment is a very attractive alternative in our setting. Compliance is a concern at our clinic. Out of 231 booked patients, 80 (34.6%) did not attend in the first 6 months of 2005. Loss to follow-up was assessed at an audit done in September 2005; this showed that 9.9 % of patients did not come back for their histology results and 38.5% did not come back for a 6-month Pap smear after treatment.6 The workload at the colposcopy clinic has increased over the last 2 years because of the increase in the number of referrals to the colposcopy clinic. There was a long delay after the Pap smear in patients accessing the colposcopy clinic (Fig. 1). The range was between 14 and 706 days, with half of the patients arriving by 104 days.6 In South Africa cancer of the cervix and AIDS are both endemic. The incidence of cervical intraepithelial neoplasia (CIN) is between 50 % and 70 % in patients who are HIV infected in Africa.7,8 One would have anticipated an increase in the prevalence of cervical cancer but this has not yet occurred. It is possible that HIV-infected women die from other causes before they develop cancer of the cervix. With the rollou