Deciding to attend a cervical screening (smear test) appointment can be a difficult decision. Screening is very much a personal choice, and it’s important that women feel fully informed and comfortable with making the decision.
The cervical screening programme aims to detect abnormalities of the cervix early and refer women for further assessment and treatment.
The test is offered to women in England aged 25 to 49 every three years and those aged 50 to 64 every five years. The first invitation is sent at age 24.5 years.
Cervical cancer is preventable. The British Journal of Cancer (2016) estimates that in England, screening currently prevents 70% of cervical cancer deaths across all ages; however, if everyone attended screening regularly, 83% could be prevented.
Despite this, screening coverage has fallen across all age groups over the last 10 years.
Screening figures collected by NHS Digital show that coverage amongst women aged 25 to 49 years was 70.2% at 31 March 2016. This compares to 71.2% as at 31 March 2015 and 73.7% as at 31 March 2011.
For women aged 50 to 64 years, the coverage at 31 March 2016 was 78% which compares to 78.4% as at 31 March 2015 and 80.1% as at 31 March 2011.
It is often mentioned that younger women are less likely to take the test but it is evident that older women are declining to take up their screening invitation as well.
So why are older women declining?
There could be a number of factors, but we know that women aged over 50 are alongside groups including younger eligible women, ethnic minorities and lesbian and bi-sexual women more likely to be frequent non-attenders.
According to a survey carried out last year by Jo’s Cervical Cancer Trust, 1 in 3 women over 50 have delayed or not had a smear, with an average of delay of 26 months and 1 in 10 delaying over five years.
At PHE we carried out a focus group of women aged 50-64 to get their views on having a smear test. One of the women who attended was a 53 year old from Somerset.
She didn’t attend her last appointment and said she delayed going after receiving her reminder letter.
“I must admit I only went about two months after receiving my reminder letter. The reason why I didn’t go immediately was that at my age I didn’t think it was necessary to go any more as I am hitting the menopause. I also think as you get older you have more of a laid back attitude to life in general, but I’m glad I went as it’s important that you get yourself checked out to see if you’re ok.”
What are the symptoms of cervical cancer?
If you have any symptoms you should see your GP and do not wait for your next smear test appointment, as this could delay treatment.
Changes to the cervical screening programme
Last year, following a UK NSC recommendation, the government announced that screening samples will be tested for the Human Papilloma Virus (HPV) first, which is found in almost all cervical cancers (99.7%), especially in women under 35.
In most cases the woman’s immune system clears the virus, but in 20 to 30% of women this does not happen.
This group has a higher risk of cervical abnormalities which may turn into cancer. Testing for HPV will be rolled out across England in 2019 as the primary screening test for cervical disease.
It will replace the current first test called cytology. During this process samples are taken from a woman, which are then examined by a cytologist, who checks for any abnormal cells that could go on to develop into cancer.
HPV primary screening will be a more sensitive test than cytology in identifying women at risk and will lead to more accurate test results. Where HPV is not detected, over treatment and anxiety for women is minimised. It also means that women may not need cervical screening so often in future.
So what is PHE doing to increase coverage?
We’re supporting local services to encourage more women to attend screening by providing clearer information and piloting the sending of tailored text reminders.
The programme change to test for HPV first will provide an opportunity for self-testing. We are currently reviewing the evidence regarding self-testing and the UK National Screening Committee (UK NSC) will be asked to consider the merits of self-testing for women who are not taking up their invitation.
As previously mentioned, being screened is a personal choice for a woman, so she must decide if it’s right for her.
For those who do not wish to attend screening GP practices should respect their wishes and feelings and can provide information on how to be removed from the screening programme.
Screening is the best way for a woman to protect herself from cervical cancer and the Cervical Screening Programme is committed to ensuring that all eligible women who want to take the test can.
Read more about ways to make cervical screening more accessible in this edition of Health Matters which includes a set of infographics and slides to support local commissioning and service delivery, as well as best practice case studies.
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