Keele University academic calls for urgent review of cervical screening programmes

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• Uptake of cervical cancer screening declining post 50 despite increased risks
• Review points to alarming misconceptions about cervical cancer being a younger women's disease
• Calls for cervical screening age to be extended past 65

As Cervical Screening Awareness Week begins, a Keele University academic is calling for cervical screening programmes and perceptions of cervical cancer to be reviewed urgently, to encourage more older women to get regularly screened.

The review, led by Dr. Sue Sherman, senior lecturer in Psychology at Keele University, found that on average 20 per cent of the 3,121 new cases diagnosed each year, and 50 per cent of deaths from cervical cancer were in women aged 65 and over - the age at which the screening programme in the UK currently ends. This is compared to 64 new diagnoses under the age of 25, accounting for just 2% of all diagnoses.

The research also suggests that the cancer is perceived as being a young woman's disease, with the screening cut off at 64 implicitly suggesting to older women that they are no longer at risk. Figures show that uptake of cervical screening is declining after age 50, and that breast screening uptake actually increases from 50 to 64. In 2013, 82% of 50-54 year old women had been screened for cervical cancer in the past five years, dropping to 76% of 55-59 year olds, and then to 73% of 60-64 year olds.

The report - published in the British Medical Journal Monday, 15 June - also reveal in the 20 years following 65, just 8 in 10,000 women with negative test screenings between 50 and 64 are likely to contract cervical cancer. This compares to 49 in 10,000 for those who are not screened between the ages of 50 and 64, showing that being regularly screened greatly reduces the risk of diagnosis. This means women with three negative screenings for cervical cancer between the ages of 50 and 64 are six times less likely to contract the disease in later life.

A recent survey completed by Jo's Cervical Cancer Trust, the cervical cancer charity behind Cervical Screening Awareness Week (15-21 June 2015), backs this up. It found that a lack of knowledge about the cause of cervical cancer and who can be affected seems to be contributing to women aged 50-64 not attending cervical screening. Almost two thirds (60%) of women aged 50-64 do not know HPV causes cervical cancer and many failed to link historic sexual activity as a threat to the virus laying dormant and developing into cervical cancer later in life.

Dr. Sue Sherman, senior lecturer in Psychology at Keele University and lead author of the report, says: "This review suggests that older women not getting themselves screened for cervical cancer has become a significant contributor to the number contracting the disease. Despite all the attention on younger women - in part due to the Jade Goody effect - 20 per cent of new diagnoses and nearly 50 per cent of cervical cancer deaths occur in women over the age of 65. We need to change the perception of cervical cancer so it is thought of just like breast and bowel cancer - that it can affect women well into old age.

"Encouragingly we found that women with three negative tests for cervical cancer between 50 and 64 are considerably less likely to get the disease in the next 20 years. So regular screenings have the potential to catch the disease early and reduce the victims of cervical cancer dramatically. Jo's trust has also backed this up with its own investigation, and during Cervical Cancer Awareness Week from 15 -21 June we want to encourage more older women to get themselves screened for cervical cancer."

Robert Music, Chief Executive of Jo's Cervical Cancer Trust said: "This research from Keele University backs up our own investigations that there is an urgent need to not only increase survival rates for women in this age group but decrease the numbers diagnosed altogether. It's absolutely vital that women of all ages are educated around the cause of cervical cancer and their risk of HPV. Responses from women questioned in our research were worrying with some citing they had been 'celibate' for several years and therefore did not consider themselves to be at risk. We must remind all women that HPV is very common and can lie dormant for very long periods of time, and that the best way of reducing one's risk of cervical cancer is to attend screening promptly whilst eligible.

"We also found that almost a quarter said this was a disease that was most likely to affect women aged 25-34, which suggests many people associate it as a predominantly young person's cancer. Whilst it is the most common cancer in women under 35, it still affects women of all ages and we are particularly concerned that if women delay their screening over the age of 50, they increase their chances of not only a diagnosis after they have left the programme, but a later stage diagnosis with a poorer outlook."

Comments

  1. Elizabeth Eb Elizabeth Eb Australia says:

    Incredible how we confuse the issue when medical profits might be at stake, almost all women are HPV- and cannot benefit from pap smears, but can be harmed by false positives, excess biopsies and over-treatment. It's shocking that screening for a fairly rare cancer has had such a huge and negative impact on the lives of so many women.

    I'm Australian, 57 and have never had a pap test, an informed decision.

    I'm one of the rare women my age who hasn't had anything "done" to her cervix. Our program is excessive and so we have very high referral rates for excess biopsies and over-treatment. Great for vested interests, a lousy deal for women. It was the numbers I didn't like, near zero risk of cervix cancer or a 77% lifetime risk of colposcopy/biopsy, now I understand that most women are HPV- and cannot benefit from pap testing.

    Those who want to screen and yes, it's a choice and should be an informed decision, take a look at the new Dutch program. This program is based on evidence and attempts to protect all women, the roughly 5% at risk of cc and the vast majority who cannot benefit from testing. Australian and American women will never see this sort of program, the huge industries built around population pap testing and over-treatment make a fortune for so many that they'll fight to keep excess/non-evidence-based testing in place. Most women are in the dark when it comes to the evidence, so it's easy to continue with excess. Many women are also, coerced into pap testing and excess with some doctors "requiring" a pap test for the Pill, note screening can never be required for anything, it's elective and needs your informed consent.

    The Dutch will offer 5 HPV primary tests or HPV self-testing at ages 30,35,40,50 and 60 and a 5 yearly pap test will ONLY be offered to the roughly 5% who are HPV+.

    This program will save more lives and takes most women out of pap testing and harms way. The American practice of doing both HPV AND pap testing on women over 30 is about profits, this combination produces the most over-investigation for no additional benefit to women. HPV testing should always stand alone and never be used before age 30. (pap testing does not benefit those under 30 either but leads to lots of false positives and over-treatment).

    Most older women are HPV- and cannot benefit from pap testing. Also, pap testing can be very painful after menopause, it can be intolerable for some women. ALL completely unnecessary and plain cruel - allow women to test themselves for HPV, only a very small number will be HPV+...these are the only women who should be offered a pap test.

    ROUTINE pelvic, rectal, recto-vaginal, clinical breast exams, visual inspections of the genitals - they are NOT evidence-based, not recommended, and are FAR more likely to harm you. The American well-woman exam is about medical profits, it will harm you sooner or later.

    Mammograms - be careful, I've declined, head over to the website of the Nordic Cochrane Institute, an independent, not for profit, medical research group and read their excellent summary of the evidence. About 50% of screen detected breast cancers are over-diagnosed and any benefit of screening may be wiped out by those who die from heart attacks and cancers after treatments so the risks of screening may exceed any benefit.

    Women need to be careful, do their own research and make informed decisions about screening and yes, we can say NO.

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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