New types of Paps and puffs

In the US liquid-based cytology for cervical screening has replaced conventional cytology in many settings. Although there has been a lot of research on the liquid-based technology, few randomized trials have appeared. Two studies, an editorial, and a commentary in this issue add to the confidence that a move to liquid-based techniques is of both clinical and programmatic benefit.

Guglielmo Ronco and colleagues randomized over 45 000 women to receive either conventional or liquid based cytology (doi: 10.1136/bmj.39196.740995.BE). They found that the liquid technique clearly reduced the number of unsatisfactory smears with no decrease in sensitivity, although the number of false positives was increased. Liquid cytology also allows for human papillomavirus testing, which conventional smears do not.

In a prospective analysis of over 55 000 split sample pairs, Elizabeth Davey and associates found an increased sensitivity with the automated reading that is possible with liquid-based cytology compared with conventional smears (doi: 10.1136/bmj.39219.645475.55). They also found significantly fewer unsatisfactory slides with the new technology. Geoff Watts explains liquid-based cytology systems (doi: 10.1136/bmj.39260.482616.DE), and Karin Denton concludes in an editorial that although results will vary in different settings, the weight of the evidence supports the widespread adoption of liquid cytology (doi: 10.1136/bmj.39262.506528.47).

Also in this issue are two interesting articles on smoking. Paul Aveyard and Robert West review the management of smoking cessation (doi: 10.1136/bmj.39252.591806.47). They discuss nicotine dependence as the central factor leading to quit failures and thus emphasize the importance of nicotine replacement therapy. In addition to various nicotine replacement modalities and bupropion, there is a new oral drug available that has been shown to be effective: varenicline.

Just as there are new smoking cessation aids, so are there “new” forms of tobacco use. The latest craze among teenagers is hookah smoking, especially using fruit-flavored tobacco. Rashid Gatrad et al review the UK experience with hookah smoking and the evidence of its harm (doi: 10.1136/bmj.39227.409641.AD). They argue that it should be banned wherever smoking is not permitted. Kids are interested in the exotic, especially if it tastes good, so we need to be as vigilant about hookah use as we are for flavored snuff.