Advice on Cervical Cancer – latest expert guidance on dangers of screening too early

UK cervical cancer expert Adeola Olaitan warns of the dangers of screening women too young.

The American College of Obstetrics and Gynaecology has announced a change in screening policy for the prevention of cervical cancer. The previous policy recommended screening from within three years of first sexual intercourse but no later than the age of 21. Current guidelines recommend delaying the onset of screening until the age of 21.

These guidelines reflect the increasing awareness of the potential to cause harm by screening very young women. The difficulty with screening teenagers is that normal changes of the immature surface of the cervix can resemble pre-cancerous change. These changes can be wrongly diagnosed as pre-cancer and treatment can put women at risk of miscarriage and other pregnancy complications. If indeed precancerous changes occur in young women, they are most unlikely to progress to cancer before screening starts and appropriate treatment can be administered.

It was with this in mind that the National Health Service Cervical Screening Programme raised the minimum age of screening to 25 years in 2003. This change in policy has not been without controversy particularly as there have been highly publicised deaths from cervical cancer of at least two women in their early twenties. Despite the intense media reporting of these cases, it is important to realise that cervical cancer remains an extremely rare disease in women under 25 years of age.

The important message is that women too young to be screened do not ignore symptoms that might suggest cervical cancer. They should report bleeding after sex and bleeding between periods to their general practitioner and appropriate investigations should be undertaken. The screening services both here and in the USA should carefully monitor the effects of the changes in screening policy.