Why cervical screening has changed
As New Zealanders, we are lucky to have had a robust screening programme for cervical cancer for many years. I know from talking to patients from overseas that in many parts of the world this type of screening test isn’t freely available, creating inequity of access and leading to preventable cancers in those people who are often most at risk.
Our programme here isn’t perfect – we, too, have our equity of access and funding issues – but it has had a huge impact. Over the decades since it was introduced, it has halved the rate of cervical cancer and saved the lives of many women.
However, as fortunate as we are to have access to this type of screening, no-one I am sure looks forward to the time their smear test is due. It’s not the most dignified thing to visit your doctor or nurse, remove your lower clothing and leap up onto the couch, exposing your nether regions, even if it is quick and relatively painless.
I suspect the idea of a smear test can sometimes be even harder for younger women, many of whom won’t have had any type of genital examination before.
So the good news is that, as of next month, the recommended age for getting your first smear test is changing – from 20 to 25 years old.
According to Simon McDowell, a Wellington gynaecologist, ‘‘the updated guidelines are a response to better knowledge and clearer evidence. They will reduce the burden on young women and the health sector in general’’.
He tells me that the rationale behind this recommendation is based partially on the fact that cervical cancer is rare in young women. Cervical screening aims to pick up early changes in the cells of the cervix: ‘‘pre-cancer’’, rather than cancer itself. The idea is that if we can pick up abnormalities early, before they get to develop into true cancer, then treatment itself is much simpler, nearly always curative and will prevent cancer ever developing.
As cervical cancer is so rare in this age group and the average time that it takes a pre-cancerous change to turn into cancer is around 10 years, the current advice is that we can wait until women are a little older before trying to detect these early changes.
Another reason behind the change in recommendations is that many young women have now had their HPV vaccines, known as Gardasil.
These immunisations give incredibly good protection against the highest risk strains of HPV (human papilloma virus), the virus that causes cervical pre-cancer and cancer.
The more people we have who are immune to HPV, the lower our rates of cervical cancer in the future will be. So women in the 20-25 age range (most of whom are vaccinated) are much less likely to have smear abnormalities than their older counterparts (most of whom aren’t).
The other reason for changing the age for the first smear test is that when groups of younger women have been studied, some of those who have abnormal smear tests go on to have more invasive confirmatory testing (known as colposcopy) and then doctors discover that the changes have reverted to normal with time.
I’m not sure that we fully understand why this is, but it seems to be more likely that a younger woman’s abnormal smear test will revert to
normal on its own without the need for treatment, than an older woman’s.
According to McDowell, ‘‘a colposcopy is an unpleasant procedure for women, so reducing the need for performing this test unnecessarily is a good thing. Under the new guidelines, women in the 20-24 age group will definitely have fewer of these procedures.’’
Although this new advice might sound a little counter-intuitive – we have persuaded women for many years to ensure they start screening early and get their testing done really regularly – it is based on good science and I’d thoroughly recommend that you adopt the new advice if this is applicable to you.
The regime hasn’t changed for anyone over 25 – the first two tests should be a year apart and then, if both those are normal, the others should be done at three-yearly intervals until the age of 70, when your need for screening stops. However, for those under-25, this is what you should do:
■ If you’re under 25 but have already started the screening programme: You should keep going as per the recalls you get from your health provider (for example, yearly or three-yearly, depending on your results)
■ If you’re under 25, but haven’t yet started the programme: You will be invited to attend your first screening appointment as you approach your 25th birthday. There is no reason to go any sooner than this, unless you have any concerning symptoms. If you don’t receive a reminder to get this test done, I’d recommend you take the initiative and book yourself in as close to your 25th birthday as you can. This advice applies regardless of whether you are fully immunised with Gardasil or not.
■ For anyone in any age group with worrying symptoms (including abnormal bleeding, bleeding after sex, persistent pain or discharge): Book a doctor’s appointment to have things checked out. They may or may not want to do a cervical smear test, but it is better to let them make that decision, just in case something is amiss.
Remember that cervical smears are just screening tests. That means they really just give the doctor an idea about whether or not anything could be wrong. They are not diagnostic. To get an absolute diagnosis requires further testing and will usually need a specialist’s input.
For more information about the changes to the smear programme, either talk to your doctor, or call the screening helpline on 0800 729 729.