Worldwide, cancer of the cervix is one of the most common causes of death in women. Each death is a tragedy, not only because usually the women are young, but because they leave behind young families. It is a further tragedy that, although cancer of the cervix is a disease which has almost been eradicated in countries which have introduced screening programmes, it remains the second or third most common cause of death in women in developing countries. As gynaecologists, it is our responsibility to give the best possible care to women and to that end we have a responsibility to reduce deaths from cervical cancer. We can sympathise with colleagues who work in countries where there are too few doctors for too many patients, and where the national budget for healthcare is limited. On the other hand, prevention of cervical cancer will, in the long-term, prove much cheaper and more beneficial than trying to treat cancer once it is already established.

Whatever type of screening programme is adopted, such as cervical cytology or visual inspection with acetic acid, or a combination of both (or in the future electronic real-time devices or possibly HPV screening), colposcopy is the key to eradicating this largely preventable disease.

Basic colposcopy can be learned fairly easily provided the clinician has a good basic training, which includes an understanding not only of colposcopy, but cytology and histopathology. The relationship between the various disciplines is a symbiotic relationship in as much as each is inter-dependent upon the other.

The role of colposcopy is simple - it should identify areas of pre-malignant disease, which if removed completely, will more or less guarantee that the woman will not die from cervical cancer.

Ideally the colposcopist should be seeing patients who are known to have an abnormal screening test or who have a clinically suspicious cervix, but in some countries colposcopy will be used as the primary screening procedure. However it is used, the colposcopist should bear in mind that the objective of every gynaecologist is to give the best possible quality of care available. To do this the colposcopist needs to identify how the highest quality service can be given, and then to deliver that service, but to remember that the third stage in providing a quality service is to be able to prove that the service given is, in fact, of the highest quality. To that end, audit of one's own practice is vital.

This book, edited by Péter Bősze and David Luesley, is a valuable training manual. Each author has been carefully chosen because of their special skills in their particular field and the book covers thoroughly everything which a trainee colposcopist needs to know and everything that a trained colposcopist needs to remember.

Cancer of the cervix can be beaten - if each of us waits for someone else to find a way then the battle will never be won! It is the personal responsibility of all of us as gynaecologists to ensure that a skilled colposcopy service is available to all those women who need it.

J A Jordan
President, European Federation for Colposcopy