An effective cervical smear test does not equate to an effective screening programme. A major challenge in Europe has been to formulate efficient, cost-effective, and balanced programmes, and to implement them. Improving participation and follow-up, and reducing the false-positive and false-negative rates are also important factors. This article discusses the process of implementing and maintaining effective screening programmes in European health care systems, comments on common pitfalls of such programmes, and suggests future directions.