Age-old question of cervical screening

Age-old question of cervical screening

The age at which cervical screening should commence is a source of debate, as there
are benefits and disadvantages to its early practice. This prompted
Dr Dudill to ask: should we be performing cervical screening under the age of 25?

 

Introduction

The age for commencing enrolment onto the UK’s cervical screening programme has long been debated. Recent media interest following the death of celebrity Jade Goody has been seen to positively impact on the uptake of cervical smears whilst heightening the general public’s awareness regarding the potential for cervical cancer to present under the age of 25.

The NHS cervical screening programme (NHSCSP) was first introduced in 1964 and when first audited five years later it was apparent that many cases of cervical intraepithelial neoplasia (CIN) were being missed. It seemed that those at highest risk were being missed and those with positive results were being inappropriately followed up.1

In order to encourage uptake of cervical smears and standardise screening across the United Kingdom, the department of health in 1988 insisted on the introduction of a computer-based recall system for all women between the ages of 20 and 65.2

With the introduction of the call and recall system, incidence and mortality from cervical cancer have continued to fall. Attempts to engage women with the screening programme has meant 4.24 million women were invited to attend for cervical screening in 2012, of which 3.32 million were tested…3

 

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David Warne
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References

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  2. Department of Health and Social Services, Health Services Management: Cervical Cancer Screening in Health. Circular HC (88) 1, 1988.
  3. NHS Cervical screening programme 2012 annual review. NHSCSP, 2013.
  4. Wilson, JMG. Jungner, G. (1998) Principles and practice of screening for disease. Geneva: WHO.
  5. National Audit Office, Cervical and Breast Screening in England: a report by the Comptroller and Auditor General, 1992: London.
  6. Sasieni. P, Adams. J, Cuzixk. (2003)Benefit of cervical screening at different ages: evidence from the UK audit of screening histories. Br J Cancer; 89:88-93
  7. Extraordinary Meeting to re-examine current policy oncervical screening for women aged 20-24 years taking account of any new evidence and to make recommendations to the National Cancer Director and Ministers. (ACCS), London, 2003.
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  14. Herbert et al. (2008) Cervical screening: why young women should be encouraged to be screened. J Fam Plann Reprod Health Care : 34(1)
  15. Tilbury P, Singer A, Jenkins D. CIN 3: the role of lesion size in invasion. B J Obstet Gynaecol 1992; 99: 583 – 586
  16. Collins S, Mazloomzadeh S, Winter H et al (2002) High incidence of cervical human papilloma virus infection in women during their first sexual relationship. BJOG 109:96-98
  17. Sasieni P, Castanon A, Cuzick J (2010) Impact of cervical screening on young women: a critical review of the literature. NHS Cancer Screening Programmes, (NHSCSP Publication No 31)
  18. Routine smear tests in women under 25 would Cause moRe haRm than good. NCRI Cancer Conference. Press release November 2013
  19. Kyrgiou, M. Koliopoulos,G. Martin-Hirsch PEt al. (2006) Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis. Lancet : 367;9509,489.
  20. Himes KP, Simhan HN. Time from cervical conization to pregnancy and preterm birth. Obstet Gynecol. 2007 Feb;109(2 Pt 1):314-9.
  21. Kyrgiou M, Arbyn M, Koliopoulos G, Martin-Hirsch PPL, Alamanos YP, Prendiville WJP, Paraskevaidis E. Obstetric outcomes and fertility after conservative treatment for cervical intraepithelial lesions (Protocol). Cochrane Database of Systematic Reviews 2010, Issue 4
  22. Maissi, E et al. (2005) The psychological impact of human papillomavirus testing in women with borderline or mildly dyskaryotic cervical smear test results: 6-month follow-up.Br J Cancer. Mar 28;92(6):990-4.
  23. Drolet M et al.(2012) The psychosocial impact of an abnormal cervical smear result. Psychooncology.Oct;21(10):1071-81.
  24. Gray N et al. (2006) Psychological effects of a low-grade abnormal cervical smear test result: anxiety and associated factors.Br J Cancer. May 8;94(9):1253-62.

 

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