Is it time to rethink cervical screening?

Jade Goody’s tragic story has highlighted the importance of smear tests – but could more lives be saved if they were offered earlier and more frequently?

Yes
In the UK, cervical cancer is the second biggest cancer killer of women in their early 30s after breast cancer, yet it is the most preventable form. A regular smear test can pick up abnormalities in the neck of the womb, which, in these early stages, can then be monitored and, when necessary, treated by either laser, freezing or surgery. Cervical screening – offered every three years from the age of 25 in England – saves around 4500 lives a year. But leading oncologist Dr Justin Stebbing believes earlier and more frequent testing could save even more lives. ‘As cervical cancer exists in a pre-malignant form before it develops into an invasive disease, screening should probably be more often,’ he says.
There’s also an argument it should be given younger. In fact, until 2004 women were eligible for smears from the age of 20 – and in Scotland, Wales and Northern Ireland they still are. ‘The detection rate in 20–25 year olds would be low,’ says Dr Stebbing. ‘But it would help get women used to smear tests.’ And, of course, it could prevent those rare tragic cases such as that of Claire Walker, who died shortly after her 23rd birthday, having been diagnosed with cancer at 21.
We know the cancer is caused by the human papilloma virus (HPV), which is sexually transmitted. It does take time for the virus to wreak its cancerous changes, but since the trend is for girls to be sexually active from an increasingly younger age, it makes sense to test for early signs of abnormalities earlier than 25.
The good news is, in addition to the vaccine against HPV, which may one day eradicate the need for smears altogether, there are new smear tests on the horizon that are simpler, more comfortable and with faster results, which might well be the key to beating this terrible disease.
No
There are fewer than 50 cases of cervical cancer in the under-25s reported annually – so many experts believe that it’s unnecessary to test this age group. After all, many women dread smear tests, and the lengthy wait for results can cause anxiety and concern, so why give them earlier, or more often, than absolutely necessary?
Many argue that there is insufficient evidence to suggest screening women more regularly would be beneficial. ‘Cervical changes will often return to normal without developing into serious problems. Intervening without knowing whether the cells will turn cancerous could mean that treatment and possible side-effects were unnecessary,’ says Dr Lesley Walker, director of cancer information at Cancer Research UK. And treating every abnormal cell change is not without its hazards. It can cause a weakening of the cervix, with a small risk of later miscarriage or even, rarely, infertility. Treating women unnecessarily could also clog up the system and delay treatment for those really in need. ‘Research has found that screening women under the age of 25 may do more harm than good,’ says Julietta Patnick, director of NHS cancer screening programmes.
Raising awareness that lifestyle factors can contribute towards cervical cancer might be just as important as screening for the disease: smoking, for example, is known to predispose women to the disease, while unprotected sex can increase the risk of contracting the human papillomavirus which causes cervical cancer.

Healthy verdict
While we wait for an up-to-date review of all the evidence, the best thing you can do – whatever your age – is make sure you go for your regular three-yearly test, which is thought to prevent 75 per cent of cancer cases in women who attend regularly. One positive to come from Jade’s tragic death is a 20 per cent increase in younger women going for smear tests, the number one step you can take to lower your risk.

Words: Jeannette Kupfermann