On Wednesday 24 June, it was announced that the Independent Advisory Committee on Cervical Cancer Screening (ACCS) recommended that the NHS would not lower the screening age from 25 to 20. The reasons given for this recommendation were:
- Cervical cancer is very rare in women aged under 25 - 56 cases in women aged under 25 in England in 2006 (2.4% of all cases).
- There is no clear evidence of an increase in the incidence of cervical cancer following the change to the screening age limit in England.
- No new scientific evidence was available to support the reintroduction of screening in women aged under 25.
- There is evidence that treatment following screening in this age group can lead to an increased risk of subsequent premature births, increasing the risk of babies dying or having disabilities.
- One in three young women screened aged under 25 would have an abnormal result, as opposed to one in 14 for all women screened. This means there are very large numbers of false positive in young women causing anxiety and leading to unnecessary investigations.
- This is in line with the advice from the World Health Organisation and is supported by the UK’s leading scientists
The push for a lowering of the age of screening came from a media campaign led by The Sun and Grazia (women’s magazine) as part of their coverage of the Jade Goody story. In Parallel, relatives of Claire Walker who died of cervical cancer at the age of 23 led a similar campaign which was reported by The Sunderland Echo. Jo’s Trust, a cervical cancer charity, has also backed this campaign.
On the 13th of March, a formal review of the age of screening was announced. The review concluded on 19th May 2009. The committee was unanimous in rejecting the option to start screening women from the age of 20. Recommendations were made to improve symptom recognition by GPs and practice Nurses.
Consultant Gynaecologist, Adeola Olatain responds:
The issue of cervical cancer in young women is an emotive one, particularly following the recent frenzied media coverage of one woman’s death. It was appropriate therefore that there was an independent review of the evidence and that we should accept the findings of an independent scientific committee. It would be helpful if the ACCS published the evidence they used to back their recommendation. In addition, the incidence and clinical pathway of cervical cancer in young patients should be continuously audited and subsequent reviews ordered as required.
It is important to remember that cervical cancer remains rare in young women. If a woman under the screening age presents with symptoms suggestive of cervical cancer, what is required at that point is not a smear, which is a screening test, but immediate referral to the appropriate specialist so that her symptoms can be fully investigated and treatment commenced for the diagnosed condition. Cervical cancer, if diagnosed early enough, is fully treatable, with the option of preserving fertility potential. The campaign to raise awareness among GPs and practice nurses will ensure that women are referred early and appropriately.
The media, rather than clamouring for a lowering of the screening age, should concentrate on raising awareness of important symptoms in young woman and encouraging them to seek help as required. In addition, promoting risk reducing behaviour such as smoking cessation, condom use and acceptance of the HPV vaccination, will do far more to reduce the mortality and morbidity of cervical cancer in women under the age of 25.
