Currently, screening programmes for cervical cancer usually rely on cytology as the first-line screen.1 Women who are found to be cytologically abnormal are triaged by carcinogenic human papillomavirus (HPV) DNA testing or by repeat cytology, or are referred directly for a colposcopic examination. At colposcopy, biopsies are taken from any apparent lesions. Treatment is decided on the basis of the combined cytological, colposcopic, and histological diagnoses during the patient's history. These decision processes are formalised in complex consensus management algorithms that narrow down the clinical management options to a single course of action.

Controversy arose earlier this year when Smith and colleagues1 reported that women who were BRCA-mutation-negative, but from BRCA-mutation-positive families (ie, at least one family member with a deleterious mutation in BRCA1 or BRCA2) had a five-times higher risk of developing breast cancer than women in the general population. In their smaller prospective data subset, the relative risk (RR) was 2·1, which was still high, but no longer significant. To many, this was an unexpected, implausible result but, if true, these findings could have major implications—current practice is to counsel women who are mutation-negative that their breast-cancer risk is not increased beyond that of age-matched women without a family history of breast cancer, thereby allowing recommendations aimed at the general population to guide their mammographic surveillance.